WORKPLACE STRESS: a Collective Challenge

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LABOUR ADMINISTRATION, LABOUR INSPECTION AND OCCUPATIONAL SAFETY AND HEALTH BRANCH LABADMIN/OSH A COLLECTIVE CHALLENGE Tel: +41 22 799 67 15 Fax: +41 22 799 68 78 ISBN: 978-92-2-130641-2 WORLD DAY FOR SAFETY AND HEALTH AT WORK Email: [email protected]

www.ilo.org/safeday 28 APRIL 2016

WORKPLACE STRESS: A collective challenge

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Workplace stress: A collective challenge ISBN: 978-92-2-130641-2 (print) 978-92-2-130642-9 (web pdf)

Also available in French: Stress au travail: un défi collectif, 978-92-2-230641-1 (print), 978-92-2-230642-8 (web pdf), Geneva, 2016; and in Spanish: Estrés en el trabajo: un reto colectivo, 978-92-2-330641-0 (print), 978-92-2-330642-7 (web pdf), Geneva, 2016.

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Printed by the International Training Centre of the ILO, Turin – Italy TABLE OF CONTENTS

INTRODUCTION ...... 2

1. WHAT IS WORK-RELATED STRESS? ...... 2 THE CAUSES 2 THE PROTECTION OF MENTAL HEALTH AT WORK 4

2. WHAT IS THE IMPACT OF STRESS IN THE WORKING POPULATION? ...... 5 THE MAGNITUDE OF THE PROBLEM 5 IMPACT ON WORKERS HEALTH, SAFETY AND WELLBEING 6 PREVALENCE 7 THE GENDER DIMENSION 9 IMPACT ON PRODUCTIVITY AND ECONOMIC COSTS OF WORK-RELATED STRESS AND ASSOCIATED MENTAL HEALTH DISORDERS 9

3. WHAT IS THE EXISTING LEGAL FRAMEWORK ON WORK-RELATED STRESS AND MENTAL HEALTH AT WORK? ...... 11 INTERNATIONAL LABOUR STANDARDS 11 REGIONAL STANDARDS 11 NATIONAL LEGISLATION 12 INCLUSION OF WORK-RELATED STRESS AND MENTAL DISORDERS IN NATIONAL LISTS OF OCCUPATIONAL DISEASES 14 NON-BINDING TECHNICAL STANDARDS ON PSYCHOSOCIAL RISKS PREVENTION AND MANAGEMENT 14 SOCIAL PARTNERS’ AGREEMENTS 15 LABOUR INSPECTION 15

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS ...... 17 INTERNATIONAL ORGANIZATIONS 17 REGIONAL ORGANIZATIONS AND INSTITUTIONS 18 NATIONAL STRATEGIES AND INITIATIVES 19 SOCIAL PARTNERS’ ENGAGEMENT 23 PROFESSIONAL ASSOCIATIONS’ AND NETWORKS’ CONTRIBUTION 25

5. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS ...... 26 EXPERT OPINION SURVEY 26 FORESIGHT OF FUTURE SCENARIOS 28 FINDINGS AND GLOBAL TRENDS 29

6. WHY IS IT NECESSARY TO HAVE A COLLECTIVE APPROACH TO PREVENTING AND CONTROLLING THE CAUSES OF WORK-RELATED STRESS? ...... 30

CONCLUDING REMARKS ...... 32

REFERENCES ...... 33

ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS ...... 36

ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS ...... 42

BIBLIOGRAPHY ...... 49

1 INTRODUCTION 1. WHAT IS WORK-RELATED This report aims at presenting trends on work-related stress in both developed and developing countries with a view to raising awareness of the magnitude of the problem in the new context of STRESS? the world of work. To this end it provides an interregional overview of the prevalence and impact of work-related stress, and examines legislation, policies and interventions for its management at international, regional, national and workplace levels. Through a The term “stress” is used in numerous ways today, describing Delphi survey it further identifies and assesses future scenarios and everything from feeling ill in the morning to anxiety leading to contributing factors in this field. The results of this study will also depression. Among certain scientific groups, it has both negative be used in supporting ILO constituents to take action in this field at and positive connotations. Within the context of this report, stress national and enterprise levels. will only be considered as having a negative impact and will be dealt with in the framework of the workplace. Stress is not a health Focusing on the study of stress in the world of work has impairment, but is the first sign of a harmful physical and emotional increased since the 1990s, particularly on the impact of work- response. related stress on workers’ health and its management. There has been growing attention on the effects of psychosocial hazards The definition of stress and the terminology to refer to psychosocial and risks and work-related stress among researchers and hazards and risks has changed over the years. The term “stress” policymakers. Occupational safety and health (OSH) practice has was first used by Hans Selye in 1936 to define stress in biological expanded beyond its traditional scope to incorporate behavioural terms as “a non-specific response of the body to any demand of medicine, occupational health psychology and social wellbeing, change”.1 His research led to the study of stress in brain functions. thereby acknowledging people’s need to conduct a socially and He also defined “stressors” as events that trigger a physiological economically productive life. and psychological response from the organism, in order to distinguish stimulus from response.2 In this context a stressor can Today workers all over the world are facing significant changes be a biological agent, an environmental condition, an external in work organization and labour relations; they are under greater stimulus, or an event. Stress can define a negative condition or a pressure to meet the demands of modern working life. With the positive condition that responds to a stressor and that can have pace of work dictated by instant communications and high levels an impact on a person’s mental or physical health and wellbeing.I of global competition, the lines separating work from life are Today health is acknowledged as a combination of biological, becoming more and more difficult to identify. psychological (thoughts, emotions, and behaviour), and social Psychosocial hazards such as increased competition, higher (socio-economical, socio-environmental, and cultural) factors.3 expectations as regards performance and longer working hours For the ILO stress is the harmful physical and emotional response are all contributing to an ever more stressful working environment. caused by an imbalance between the perceived demands and the In addition, owing to the current economic recession that is perceived resources and abilities of individuals to cope with those augmenting the pace of organizational change and restructuring, demands. Work-related stress is determined by work organization, workers are increasingly experiencing precarious work, reduced work design and labour relations and occurs when the demands work opportunities, fear of losing their jobs, massive layoffs, of the job do not match or exceed the capabilities, resources, unemployment, and decreased financial stability, with serious or needs of the worker, or when the knowledge or abilities of consequences for their mental health and wellbeing. Work-related an individual worker or group to cope are not matched with the stress is now generally acknowledged as a global issue affecting expectations of the organizational culture of an enterprise.4 all professions and all workers in both developed and developing countries. In this complex context, the workplace is at the same time an important source of psychosocial risks and the ideal venue for addressing them with a view to protecting the health and wellbeing of workers through collective measures. THE CAUSES It is a universal principle that people have the right to the highest The workplace factors that can cause stress are called attainable standards of health. Without health at work a person psychosocial hazards. The ILO defined psychosocial factors cannot contribute to society and achieve wellbeing. If health at (hazards) in 1984, in terms of “interactions between and among work is threatened, there is no basis for productive employment work environment, job content, organizational conditions and socio-economic development. The burden of mental ill- and workers’ capacities, needs, culture, personal extra-job health is highly relevant to the world of work. It has an important considerations that may, through perceptions and experience, impact on people’s wellbeing, reducing employment prospects influence health, work performance and job satisfaction”. This and wages, with a deleterious effect on families’ income and definition emphasised the dynamic interaction between the enterprises’ productivity, and causing high direct and indirect costs work environment and human factors. A negative interaction to the economy. between occupational conditions and human factors may lead to emotional disturbances, behavioural problems, biochemical and neuro-hormonal changes, presenting added risks of mental or physical illness. On the contrary, when working conditions and human factors are in balance, work creates a feeling of mastery and self-confidence; increases motivation, working capacity and satisfaction; and improves health.5

I Levi (1971, 1976) was the first to distinguish between positive and negative stress and to link it to the working environment. Selye defined “positive stress” as eustress as opposed to distress. Eustress refers to a positive response one has to a stressor, which can depend on one’s current feelings of control, desirability, location, and timing of the stressor (Seyle,1974).

2 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 1 · STRESSFUL CHARACTERISTICS OF WORK (PSYCHOSOCIAL HAZARDS)

CATEGORY CONDITIONS DEFINING HAZARD

CONTENT OF WORK Work environment and work Problems regarding the reliability, availability, suitability and maintenance or repair of both equipment and equipment facilities. Task design Lack of variety or short work cycles, fragmented or meaningless work, underuse of skills, high uncertainty Workload / workpace Work overload or underload, lack of control over pacing, high levels of time pressure. Work schedule Shift working, inflexible work schedules, unpredictable hours, long or unsocial hours.

CONTEXT OF WORK Organisational culture and function Poor communication, low levels of support for problem-solving and personal development, lack of definition of organisational objectives. Role in organisation Role ambiguity and role conflict, responsibility for people. Career development Career stagnation and uncertainty, under-promotion or over-promotion, poor pay, job insecurity, low social value of work. Decision latitude / Control Low participation in decision-making, lack of control over work (control, particularly in the form of participation, is also a contextual and wider organisational issue) Interpersonal relationships at work Social or physical isolation, poor relationships with superiors, interpersonal conflict, lack of social support. Home-work interface Conflicting demands of work and home, low support at home, dual career problems.

Source: Cox et al, 2000

The term has evolved over the years, from stressors, stress factors (role ambiguity), and uncertainty about the future (job insecurity).8 to psychosocial factors, psychosocial hazards or psychosocial Much of the literature on work schedules focuses on shift and risks.II The terms “psychosocial hazards” and “psychosocial risks” night work and long working hours. These factors are associated are sometimes used interchangeably in the scientific literature.III with upsetting biological circadian rhythms, reduced length A number of experts agree in defining psychosocial hazards and poor quality of daytime sleep, and conflicting work-home as those aspects of the design and management of work and demands which contribute to increasing the level of stress and its social and organizational contexts which have the potential fatigue. Finally, a number of studies have investigated the effects for causing psychological or physical harm. Today there is a of physical hazards on stress. Overall, evidence suggests that reasonable consensus in the scientific community regarding the poor physical working conditions and environment, including the nature of psychosocial hazards; however it should be noted that workplace layout and exposure to hazardous agents, can affect new forms of work and the changing working environment give both workers’ experience of stress and their psychological and rise to new hazards; and therefore the definition of psychosocial physical health.9 hazards can still evolve.6 Cox identified ten types of stressful work characteristics (psychosocial hazards), which are divided into two groups: “content of work” and “context of work”.7 See Table 1. CONTEXT OF WORK The second group, “context of work”, concerns psychosocial hazards in the organization of work and labour relations, such CONTENT OF WORK as organizational culture and function, role in the enterprise, The first group, “content of work”, refers to psychosocial hazards career development, decision latitude and control, home-work related to working conditions and work organization. The impact of interface, and interpersonal relationships at work. Aspects of workload on workers’ health was one of the first aspects of work organizational culture and function are particularly significant: the to be studied. Both quantitative workload (the amount of work organization as a task performance environment, as a problem- to be done) and qualitative workload (the difficulty of work) have solving environment, and as a development environment. Available been associated with stress. Workload has to be considered in evidence suggests that if the organization is perceived to be poor relation to workpace, meaning the speed at which work has to be in respect of these environments, then this is likely to be associated completed and the nature and control of the pacing requirements with increased levels of stress.10 Several hazardous aspects of (self-systems or machine-paced). Job content (or task design) organizational roles have been identified, including role ambiguity includes several aspects which are hazardous, such as low value and role conflict, role overload, role insufficiency and responsibility of work, low use of skills, lack of task variety and repetitiveness for other people.11 Role insufficiency (when individual’s abilities in work, uncertainty, lack of opportunity to learn, high attention and training are not fully used) is also associated with low job demands, conflicting demands and insufficient resources. satisfaction and organizational commitment.12 Four sources Uncertainty may be expressed in different ways, including lack of hazardous situations have been identified relating to career of performance feedback, uncertainty about desirable behaviour development, namely: mergers and acquisitions; retrenchment and budget cutbacks; ambiguity and insecurity regarding one’s job future; and occupational locking-in.13 Participation in decision- II Stress has also been wrongly defined as a psychosocial hazard instead of as one making and control are important positive aspects of job design of their consequences. and work organization. III As in the OSH discipline, a hazard is the intrinsic property or potential capacity of an agent, process or situation (including the working environment, work According to the theoretical model developed by Karasek organization and working practices with adverse organizational outcomes) to and colleagues,IV participation in decision-making moderates cause harm or adverse health effects at work. Risk is the combination of the the stressor effects of job demands and leads to reduced likelihood of a hazardous event and the severity of health damage to a worker caused by this event. The relationship between hazard and risk is exposure whether immediate or long term. In this context, it includes both physical and psychological outcomes. For the purpose of this report, risk is the likelihood or IV Robert Karasek designed the Job Demand-Control-Support Model (JDCS), a probability that a person will be harmed or experience adverse health effects if management model of job strain. This model predicts that mental strain results exposed to a psychosocial hazard. from the interaction of job demands and job decision latitude.

1. WHAT IS WORK-RELATED STRESS? 3 TABLE 2 · WORKPLACE COLLECTIVE MEASURES TO PREVENT WORK-RELATED STRESS

Control ensuring adequate staffing levels allowing workers a say in how their work is to be carried out Workload regularly assess time requirements and assign reasonable deadlines ensure that working hours are predictable and reasonable Social support allow for social contact between workers maintain a workplace that is free of physical and psychological violence ensure that there are supportive relationships between supervisors and workers provide an infrastructure in which supervisory staff take responsibility for other workers and there is an appropriate level of contact encourage workers to discuss any conflicting demands between work and home reinforce motivation by emphasizing the positive and useful aspects of the work Matching the job and match jobs to the physical and psychological skills and abilities of the workers the worker assign tasks according to experience and competence ensure proper utilization of skills Training and education provide adequate training to ensure that worker skills and jobs are matched provide information on psychosocial risks and work-related stress and how to prevent them Transparency and ensuring tasks are clearly defined; fairness assigning clear roles, avoiding role conflict and ambiguity; providing job security to the extent possible; providing adequate pay for work performed; ensuring transparency and fairness in procedures for dealing with complaints Physical working providing appropriate lighting, equipment, air quality, noise levels environment avoiding exposure to hazardous agents taking into account ergonomic aspects to limit workers’ stress.

Source: ILO (2012b)

psychological strain.14 Overall, research indicates that greater victims but also the witnesses, particularly in jobs involving a great opportunities for participating in decision-making are associated deal of teamwork and customer orientation.20 Violence can also be with greater satisfaction and a higher feeling of self-esteem.15 In a consequence of psychosocial hazards and work-related stress. the long term, even small amounts of autonomy in the execution For example, several organizational factors have been identified of tasks are beneficial for the mental health and productivity of as contributing to the occurrence of bullying, such as stressful workers.16 The link between work and home is increasingly being jobs, monotonous jobs, low level of control, role conflict ambiguity, recognised as a potential source of stress, particularly for dual excessive workload, poor conflict management, and organizational career couples and those experiencing financial difficulties or life changes.21 crises.17 An appropriate balance between work and private life can Examples of collective workplace actions to manage stress are be difficult to achieve, in particular when workers are experiencing presented in Table 2. fast-paced and intensive work, shift work, irregular working hours, unsympathetic treatment by management and co-workers, and a lack of control over the content and organization of work.18 Social relationships both inside and outside the workplace are most commonly viewed as playing a moderating role, while adverse effects of exposure to other psychosocial hazards are more likely THE PROTECTION OF MENTAL or more pronounced when relationships provide little support.19 Another important issue is workplace violence, which can generate HEALTH AT WORK V elevated stress levels. Episodes of violence can affect not only the Since the 1960s it has become evident that organizational and managerial practices influence the mental health of workers and that their impact varies between organizations.22 But only recently V The ILO defines workplace violence as “any action, incident or behaviour that departs from reasonable conduct in which a person is assaulted, threatened, harmed or concern for the wellbeing of workers, and not merely for their injured in the course of, or as a direct result of his or her work.” Physical violence capacity to be productive in organizations, has been bringing refers to the use of physical force against another person or group that results in about changes in management practices and occupational safety physical, sexual or psychological harm. It includes beating, kicking, slapping, stabbing, shooting, pushing, biting, and pinching among others. Psychological violence and health. (emotional abuse) is the intentional use of power, including the threat of physical force, against another person or group that can result in harm to a person’s physical, Traditional approaches to occupational health, behavioural mental, spiritual, moral or social state or development. It includes verbal abuse, medicine and organizational psychology have been challenged by bullying/mobbing, harassment, and threats. Bullying and mobbing are repeated and the new social and economic contexts influencing the search for offensive behaviours in the form of vindictive, cruel, or malicious attempts to humiliate or undermine an individual or a group of workers (the difference is that bullying is done new perspectives of positive organizational behaviour in support of by one person, whereas mobbing is done by a group of people ganging up on one the potential for meaningful work and wellbeing. The first studies person). Much has been written concerning the different forms of violence at work, in on health and wellbeing reoriented the approach away from how particular psychological harassment. This report does not intends to reflect the wealth pre-existent mental illnesses affected organizational efficiency of research carried out on the subject over the years, but to make reference to those aspects closely related to the purpose of this report. towards an understanding of the effects of work on mental health,

4 WORKPLACE STRESS: A COLLECTIVE CHALLENGE both positive and negative.23 For example, in several studies role ambiguity, role conflict, overload (quantitative and qualitative), withdrawal, low self-confidence, low job satisfaction and job 2. WHAT IS THE tension have all been found to be related to stress. However, interpersonal relations and social support, as well as personality factors, can moderate their impact.24 IMPACT OF STRESS In the prevention of chronic non-communicable diseases evidence- based research has stimulated health policymakers to look for the IN THE WORKING influences not only on individual behaviours and lifestyles but also on social economic and health inequalities and working conditions, and in particular work demands; examples of their work being the POPULATION? job strain model,25 and the effort-reward imbalance model.26 These studies have shown the long-term benefits of even small amounts of autonomy in the execution of tasks to the mental health and productivity of workers.27 This section is based on an assessment of the prevalence of work-related stress among the working population in different The current nature of work has brought about a shift in the focus countries. It also summarises its impact on workers’ health, safety of research more towards health and job satisfaction, performance and wellbeing, as well as its influence on the enterprise and its management, organizational effectiveness, job insecurity and productivity. unemployment, presenteeism (sickness presence at work despite that sick leave should be taken) and absenteeism (not showing up for scheduled work), increased cultural diversity and technological change. Greater attention has also been placed on the preservation of the mental health of workers, the positive THE MAGNITUDE OF THE aspects of health and wellbeing, and the organizational factors involved in improving them.VI Accordingly, contemporary studies PROBLEM have shown the importance of the social environment in shaping work behaviours and valuing them, and therefore the role of human In recent decades, globalization and technological progress resource policies in ensuring working relationships based on trust, have transformed the world of work, introducing new forms of authenticity and partnership.28 work organization, working relations and employment patterns and contributing to the increase of work-related stress and its From an ILO perspective, the protection of mental health at associated disorders. Globalization has given rise to considerable work has more impact if it focuses on preventive strategies. new openings for economic development, but also to the danger Occupational health and workplace health promotion measures of global competitive processes, placing pressure on working can contribute to improving the mental health and wellbeing of conditions and respect for fundamental rights.29 Globalization has women and men at work and reducing the risk of mental health led to changes in employment patterns through greater flexibility disorders. This implies an occupational health practice that involves in the work process, more part-time and temporary employment protecting workers’ health through psychosocial risk assessment and independent contracting of staff.30 These practices can and management for the prevention of work-related stress and result in higher job demands and job insecurity, lower control work-related mental diseases. and an increased likelihood of layoff of workers.31 Technological advancement and the emergence of the internet have led to many changes and innovations in work processes, making the boundaries between work and personal life more and more difficult to identify. Workers might feel that staying connected longer and responding quickly is a sign of good performance, continuing in practice to do their job at home and outside working hours.32 Incompatibility between work roles and family roles causing behaviour-based, time-based and strain-based conflicts at work can make role demands in the family difficult or impossible to meet, and vice versa.33 The recent global economic crisis and recession contributed to increases in unemployment, poverty and social exclusion. Their consequences have forced many enterprises to scale down their economic activity in order to remain competitive, with a boost in restructuring, downsizing, merging, outsourcing and subcontracting, and massive layoffs. Restructuring processes extend beyond the effects of layoffs. Organizational change causes uncertainty and antagonisms and workers that survive downsizing may experience feelings of guilt towards their dismissed colleagues. Besides the fear of losing their jobs workers have also to handle reduced opportunities for advancement. In addition, those remaining in employment may be required to be more flexible and perform new tasks, facing increased workloads, working hours, lack of control and role ambiguity.34 Evidence from previous crises showed that restructuring and organizational changes over such a period lead to decreased attention in the management of workplace risks under pressure for a necessary reduction in costs. As safety and health at work is still perceived by many enterprises as a cost rather than an investment, some of them reduce costs VI It has to be noted that pioneers in these areas started work long ago, but only by disregarding OSH standards. The decrease in public spending much later has this approach become part of mainstream thinking; the trends also compromises the capacities of labour inspectorates and other that have changed the global research focus stem from the 1990s, and those OSH services in terms of delivery.35 concerning policy stem from the 2000s.

2. WHAT IS THE IMPACT OF STRESS IN THE WORKING POPULATION? 5 Work is fundamental to human health to the extent that people lifestyle behaviour which may increase health risks. Available prefer bad working conditions to unemployment. Work not only evidence shows that psychosocial risks (such as job insecurity, low provides financial resources, but contributes to basic psychological control, high demands, effort-reward imbalance) and work-related functions such as a time structure, social contacts and a personal stress are associated with health-related behavioural risk, including identity.36 Unemployment is related to lower life satisfaction, social heavy alcohol consumption, overweight, less frequent exercise, stigma, loss of self-esteem and loss of social contacts, with increased cigarette smoking, and sleep disorders.45 Several negative consequences for mental health.37 Several studies have studies focus on the relationship between psychosocial risks and shown how unemployment requires individuals to assume new and working conditions and alcohol abuse, showing that perceived difficult roles, handle uncertainty and unpredictability, and cope stress, workload (including long working hours), effort-reward with feelings of loss of control and identity issues.VII Unemployment imbalance and workplace harassment are important determinants is also associated with an increased risk of drug use, alcohol use of risky drinking.46 Differences in psychosocial risk exposure disorders, unhealthy diet, physical inactivity, and poor sleep.38 It is between men and women show different patterns of tobacco also associated with mental health disorders such as depression consumption: high job strain, job pressure, and excessive working and suicide.39 hours are associated with smoking in men, while for women the main psychosocial risks related to smoking are high demands Over the past decades a growing body of evidence has (both psychological and physical) and effort-reward imbalance.47 demonstrated the impact of psychosocial risks and work-related The impact of such unhealthy behavioural patterns is evident, stress on workers’ health, safety and wellbeing and organizational as every year around six million deaths are caused by tobacco performance. Research clearly indicates that the relationship and over three million are attributable to alcohol consumption.48 between work-related stress and both physical and mental Furthermore, unbalanced nutrition and insufficient physical activity health disorders is consistent. Within the workplace, the result are the main causes of obesity and are key risk factors for non- is increased absenteeism and presenteeism, disturbed labour communicable diseases (NCDs) such as cardiovascular disease, relations, reduced motivation of staff, decreased satisfaction and cancer and diabetes.49 Therefore, reducing workplace related creativity, increased staff turnover, internal transfers and retraining, factors associated with these unhealthy lifestyles and NCDs and generally a poorer public image. These problems have a contributes to the general health and wellbeing of the population. considerable impact on productivity, on direct and indirect costs, Several studies focusing on sleep disorders show a bi-directional and on the competitiveness of the enterprise. relationship between sleep disturbances and work-related psychosocial risks (including job strain, high level of demands, low level of control, low level of social support, long working hours and shift work, and effort-reward imbalance).50 IMPACT ON WORKERS Cardiovascular disease (CVD) is the first cause of death globally,VIII with an estimated 17.5 million deaths in 2012 (thirty-one per cent HEALTH, SAFETY AND of all global deaths).51 The rates of coronary heart disease vary across occupations, suggesting that working conditions might WELLBEING play a causal role.52 The majority of approximately 30 reports derived from large scale studies provide evidence of elevated The impact of stress on health can vary according to individual risk of fatal or non-fatal cardiovascular (mostly coronary) events response; however, high stress levels can contribute to developing among those reporting work-related stress.53 Overall, risks are health-related impairments, including mental and behavioural at least fifty per cent higher among those suffering from stress at disorders such as exhaustion, burnout, anxiety and depression, as work in comparison with those who are not. Even if the available well as other physical impairments such as cardio-vascular disease evidence supports a correlation between work-related stress and musculoskeletal disorders. Growing attention is also being and CVD,54 only a few studies have indicated a direct pathway paid to the impact of emerging coping behaviours such as alcohol between job strain and heart disease which may include: and drug abuse, smoking, unhealthy diet, poor sleep, as well as increased autonomic nervous system activity (e.g. increased heart to their relation with an increasing rate of workplace accidents and rate), raised blood pressure with increased risk of hypertension, non-communicable diseases. increased catecholamine and cortisol levels, decreased fibrinolytic activity and predisposition to thrombosis, and increased mass of Early research on occupational accidents was looking into the left ventricle.55 Several high-quality epidemiological studies “accident-prone” workers in order to manage accident rates demonstrate a positive association between psychosocial risks at through the selection process (i.e. excluding certain workers). work and CVD.56 Findings are consistent across regions, indicating Today many studies suggest that human error plays a small role a relationship between exposure to a poor psychosocial working in workplace accidents and that unsafe behaviour is motivated by environment (also mediated by adverse health behaviour) and efficiency, time management pressures and lack of training, and is heart disease. Key psychosocial risk factors include: job demands, not necessarily due to the individual worker.40 A growing number low job control, low support levels, effort-reward imbalance, job of studies are investigating the association of poor psychosocial insecurity, and job dissatisfaction.57 Working time arrangements, work environment and work-related stress with increased risk including long working hours and shift work, have also been found of occupational accidents.41 The experience of either cognitive to be associated with an increased incidence of CVD.58 or physical symptoms of work-related stress can increase the likelihood of momentary distraction, errors in judgement, or failure Musculoskeletal disorders (MSDs) are the focus of considerable in normal activities.42 Evidence clearly suggests that factors such attention and research in OSH, which is in part due to high as high workload and job demands, low decision latitude, low skill prevalence rates and the associated costs. MSDs are the most discretion, lack of organizational support, conflicts with supervisors common cause of severe long-term pain and physical disability, and colleagues, or highly monotonous work are linked to a higher and they affect hundreds of millions of people around the world. likelihood of injury in an occupational accident.43 Findings also The role of psychosocial factors and work-related stress in the indicate that mental ill-health (in particular burnout) is negatively development of MSDs has received increased attention. Indeed related to safe working practices, increasing the likelihood of a a number of epidemiological studies have been conducted in workplace accident.44 different sectors (from office work to manual work), repeatedly A number of studies show that stressful working conditions can impact on workers’ wellbeing by directly contributing to harmful VIII CVD is a group of disorders of the heart and blood vessels. They include coronary heart disease; cerebrovascular disease; peripheral arterial disease; deep vein thrombosis and pulmonary embolism; and rheumatic and congenital heart disease. Heart attacks and strokes are usually acute events, mainly due to an VII The pioneer in this type of research was Warr (1999). obstruction preventing the blood from flowing to the heart or brain.

6 WORKPLACE STRESS: A COLLECTIVE CHALLENGE showing linkages between work-related psychosocial factors mortality and of prolonged years affected by disability.75 The and MSDs. Overall, it is evident that the incidence of MSDs is large majority of results from a number of studies confirm that associated with high perceived work-related stress levels, high the risk of depression increases up to four times, among workers workload and demands, low social support, low job control, low experiencing work-related stress, depending on the measure, job satisfaction, and monotonous work.59 Effort-reward imbalance gender and occupational group under study.76 and difficulties in communicating with colleagues and supervisors, Many high-quality studies have been conducted, showing that as well as workplace violence (in particular harassment, bullying, psychosocial hazards and work-related stress precede the onset of and intimidation) have been shown to be associated with MSDs.60 depression.77 Given the burden of this disease, it is not surprising Burnout is a state of physical, emotional and mental exhaustion that the majority of studies on psychosocial risks, work-related that results from long-term involvement in work situations that stress and ill health have examined their link with depression. are emotionally demanding.61 The Burnout Syndrome can be A large number of studies found that poor mental health and described as a prolonged response to chronic exposure to depression are associated with workload (including long working emotional and interpersonal psychosocial risks on the job.IX It hours and high physical, psychological or emotional demands), is characterized by emotional exhaustion, cynicism (negative, low decision latitude, low support, effort-reward imbalance, job dehumanized, and insensitive attitudes towards people who insecurity, and organizational restructuring.78 Other psychosocial are the recipients of one’s services), depersonalization, lack of factors found to be associated with depression include involvement at work, low level of personal accomplishment and compromised work-life imbalance, job dissatisfaction, role conflict inefficiency.62 Burnout may occur when there is a disconnection and ambiguity, poor relationships at work, over-commitment, low between the organization and the individual with regard to the main pay, focus on career development, and poor justice at work.79 areas of working life: values, fairness, community, reward, control, Several studies also found that exposure to bullying or mobbing are and workload.63 Burnout is mainly the result of the following risk factors for both depressive symptoms and anxiety.80 According psychosocial factors: high or unmanageable workload (quantitative to the World Health Organization (WHO), gender represents a and emotional demands), role ambiguity, organizational changes, critical determinant of mental disorders such as depression, anxiety low job satisfaction and personal accomplishment, unsuitable and somatic complaints. Gender-specific risk factors for common work-life balance, poor interpersonal relations and support at mental disorders that disproportionately affect women include work, and workplace violence, including harassment and bullying.64 gender-based violence, socioeconomic disadvantage, low income Headache, insomnia, sleep and eating disorders, tiredness and and income inequality, low or subordinate social status and rank, irritability, emotional instability and rigidity in social relationships and unremitting responsibility for the care of others.81 are some non-specific symptoms associated with the Burnout Every year over 800,000 people die by suicide according to the Syndrome.65 The Burnout Syndrome has also been associated WHO.82 Over seventy-five per cent of all suicide deaths occur in with alcoholism and health problems such as hypertension and low- and middle-income countries and most deaths by suicide myocardial infarction.66 Other effects can be reduced energy, sleep are among people of working age. Suicidal behaviours have been disorders, and neuro-vegetative and functional complaints.67 associated with depressive symptoms. The link between suicide The incidence of burnout and its recognition has increased and mental disorders (in particular, depression and disorders substantially over the past years and several studies have been associated with substance abuse) is well established.83 Frequently, carried out in many countries to examine its causes, the most several risk factors act cumulatively to increase a person’s significant among them being work-related stress.68 Furthermore, a vulnerability to suicidal behaviour, including those at the level of growing number of studies show that female gender is associated the individual (e.g. previous suicide attempts, mental disorders, with increased burnout risk.69 This can be explained by the fact harmful use of alcohol or drugs, financial loss, chronic pain and a that several psychosocial factors related to burnout and work- family history of suicide).84 However, suicide intentions may also related stress may be more frequent for women (e.g. the double emerge due to psychosocial risks associated with legal crises, role that they have to play at home and at work; the gender roles discrimination, isolation, conflicting relationships, physical or of society and the influence of social expectations; the risk of psychological abuse, and academic or work-related problems. sexual harassment at work and domestic violence; and gender- based discrimination reflected in lower wages and higher job requirements).70 For example, in Sweden a cross-sectional study from the Monitoring of Trends and Determinants in Cardiovascular Disease project (MONICA, 2010) reported that in women a PREVALENCE poor socioeconomic position was associated with burnout. Unfavourable working conditions and life situational factors may Prevalence data on psychosocial hazards and work-related stress explain the high level of burnout in Swedish women vis-à-vis are available to varying extents across countries and regions; X men.71 however, the quality varies considerably. The greater share of research in this field is to be found in Europe and North America, Depression is a common mental disorder. Globally it is estimated and in general in developed countries, but to a lesser extent in the to affect 350 million people and is one of the leading causes of Asia-Pacific region and Latin America, and to only a limited extent mental disability for both women and men.72 It is characterized by in Africa and the Arab States. depressed mood, loss of interest or pleasure, decreased energy, feelings of guilt or low self-worth, disturbed sleep or appetite, Regional data in Europe are mainly collected and assessed th and poor concentration. These problems can become chronic or by European Union (EU) agencies. The 4 European Working XI recurrent and lead to substantial impairments in the ability to take Conditions Survey (EWCS, 2007) revealed that an estimated 85 care of everyday responsibilities.73 Depression often comes with 40 million people in the EU were affected by work-related stress. symptoms of anxiety, which is an emotion characterized by feelings According to the European Risk Observatory Report published of tension, worry and physical changes such as increased blood in 2009, work-related stress represented in Europe between 86 pressure. People with anxiety disorders usually have recurring fifty and sixty per cent of all lost working days. The study also intrusive thoughts or concerns, and may have physical symptoms found that on average twenty-two per cent of the European such as sweating, trembling, dizziness or a rapid heartbeat.74 From a global perspective, depression is a leading cause of premature

X Prevalence is the percentage of a population that is affected with a particular disease at a given time. Incidence is the frequency with which a disease or trait IX The Maslach Burnout Inventory (MBI) was design to assess emotional exhaustion, appears in a particular population or area. depersonalization, and diminished personal accomplishment. The model is the XI Since 1990 the European Working Conditions Survey (EWCS) assesses the more widely used tool and has been used extensively since the 1970s (Maslach, psychosocial working environment, including job context, working time, work 1976). intensity, career prospects and work organisation.

2. WHAT IS THE IMPACT OF STRESS IN THE WORKING POPULATION? 7 workforce was under stress, with levels markedly higher in the eight point nine per cent of employers and seven per cent of newer member States (thirty per cent) than in the older member workers pointed out that prevention initiatives on these issues had States (twenty per cent). Stress was most prevalent in the been implemented during the preceding months.94 In addition, the education and health sectors, as well as in agriculture, hunting, Chilean Safety Association (ACHS) stated that twenty-one per cent forestry and fishing (twenty-eight point five per cent). The largest of the 4,059 occupational diseases reported to the ACHS in 2012 group of workers who suffered from anxiety at work were those were related to mental health diseases.95 In Colombia, according to employed in education and health (twelve point seven per cent), the first National Survey on Working Conditions and Health on the public administration and defence (eleven point one per cent) and General System of Occupational Risks (2007), twenty-four point those in agriculture, hunting, forestry and fishing (nine point four seven per cent of male workers and twenty-eight point four per per cent). The First European Survey of Enterprises on New and cent of female workers ranked their level of stress between 7 and Emerging Risks (ESENER) conducted by the European Agency 10 on a 10-point scale (where 1 is “little or no stress” and 10 is “a for Safety and Health at Work (EU-OSHA) in 2009 found that great deal of stress”). Furthermore the survey highlighted customer even though work-related stress was reported among the key service work and monotonous and repetitive work as the top OSH concerns for European enterprises,XII only about half of the two psychosocial hazards as identified by about fifty per cent of establishments surveyed reported that they inform their workers respondents, followed by lack of clear definition of responsibilities about psychosocial risks and their effects on health and safety; (thirty-three point four per cent) and constantly changing and less than a third reported having procedures in place to deal expectations at work (eighteen point four per cent).96 In the United with work-related stress.87 These views were shared by managers States (US), according to the Stress in America™ survey (2015), and workers’ representatives. The report on Psychosocial risks respondents rated their stress levels as 4.9 on a 10-point scale. in Europe: Prevalence and strategies for prevention (2014) stated The most commonly reported sources of stress include money that twenty-five per cent of workers experienced work-related (sixty-four per cent), work (sixty per cent), the economy (forty-nine stress for all or most of their working time, and a similar proportion per cent), family responsibilities (forty-seven per cent) and personal reported that work affected their health negatively. Furthermore, health concerns (forty-six per cent).97 psychosocial risks were a concern for a majority of enterprises in In the Asia-Pacific region, according to the Australian Stress and Europe. Nearly eighty per cent of managers expressed concern Wellbeing Survey of 2014, almost half of the respondents cited about work-related stress, and nearly one in five considered work demands (forty-eight per cent) as barriers to maintaining a violence and harassment to be of major concern. Despite these healthy lifestyle. Consistent with the previous years’ findings, just concerns less than one-third of establishments have procedures over seven in ten Australians (seventy-two per cent) reported that in place to deal with such risks.88 The 6th European Working current stress was having at least some impact on physical health, Conditions Survey (EWCS, 2015) confirmed that intensive work with almost one in five (seventeen per cent) reporting that current is quite prevalent: thirty-six per cent of workers in the EU work stress was having a strong to very strong impact on physical “all of the time” or “almost all of the time” under pressure to meet health.98 In Japan, the Survey on the Prevention of Industrial tight deadlines, while thirty-three per cent reported working at high Accidents showed that thirty-two point four per cent of workers speed. Furthermore, almost one in six workers (sixteen per cent) reported suffering from strong anxiety, worry and stress during reported having been subject to adverse social behaviour (physical the previous year.99 In the first Korean Working Conditions Survey violence, sexual harassment and bullying or harassment).89 carried out in the Republic of Korea (2006), work-related stress In the Americas, according to the First Central American Survey affected eighteen point four per cent of male and fifteen point on Working Conditions and Health (2012),90 more than one in ten one per cent of female workers, and was significantly related to respondents reported having felt constantly under stress or strain working hours and job demands.100 In the second Korean Working (twelve to sixteen per cent), feeling sad or depressed (nine to Conditions Survey (2010), overall fatigue increased from seventeen thirteen per cent), or losing sleep (thirteen to nineteen per cent), point eight per cent in 2006 to twenty-six point seven per cent owing to concerns about working conditions.XIII In Argentina, the in 2010. However, a decrease in the levels of depression and First National Survey on Employment, Work Conditions, Labour anxiety from five point four per cent to one point one per cent was Environment and Health (2009) showed that twenty-six point seven registered, along with a similar decrease in insomnia or general per cent of workers reported mental load, considering their work as sleep difficulties from five point seven per cent to two point three excessive.91 In Brazil, a study examining sickness absences due to per cent.101 accidents and work-related diseases found that fourteen per cent Almost no information can be identified on the prevalence or of annual health benefits were due to mental illness (nine per cent incidence of psychosocial risks and work-related stress in Africa for men and sixteen point seven per cent for women).92 According and the Arab States. Two national studies assessing mental to the Canadian third National Study of Work-Life Balance (2011), disorders in the general population were identified in Africa: the high perceived stress was reported by fifty-seven per cent of South African Stress and Health study examining 12-month and respondents, increasing from fifty-four per cent in 2001 and forty- lifetime prevalence of common mental disorders in a representative four per cent in 1991 as reported in previous studies. A consistent sample of adults, and a nationally representative survey focussing proportion of respondents also reported highly depressed moods on national prevalence of poor mental health among women in (thirty-six per cent), reduction in the amount of sleep (thirty-one Ghana (2009-2010).102 However, neither of the studies included per cent), and high perceptions of poor physical health (forty- an occupational perspective. The only occupational study using a six per cent). The number of people reporting a high level of life large-scale representative sample identified focused on educators satisfaction decreased, dropping from forty-five per cent in 1991 from public schools in South Africa.103 The aim of this study was to to twenty-three per cent in 2011. Finally, just over three-quarters explore the relationship between self-reported job stress and job of respondents (seventy-seven per cent) were absent from work in satisfaction, and the prevalence of stress-related illnesses and risk the six months prior to the study, mainly due to ill health (sixty-three factors among educators. The study found very high stress levels per cent) and emotional, mental and physical fatigue (forty-five per among educators. Work-related stress and lack of job satisfaction cent).93 In Chile, according to the 7th National Survey of Working were associated with most stress-related illnesses (hypertension, Conditions (2011), twenty-seven point nine per cent of workers heart disease, stomach ulcers, asthma, mental distress, and and thirteen point eight per cent of employers reported that stress tobacco and alcohol misuse). and depression were present in their enterprises. However, just Even if in recent years there has been growing attention to work- related suicides, the proportion of suicides that are work-related XII The ESENER of 2009 covered over 28,000 enterprises in 31 countries (the 28 EU is still unclear owing to lack of data concerning the origin of member States, Norway, Switzerland and Turkey). reported suicides. However available data are alarming. Several XIII The survey was conducted in Costa Rica, El Salvador, Guatemala, Honduras, studies have examined job characteristics and the risk of death Nicaragua and Panama.The results were consistent among countries, with the from suicide among workers, highlighting the exposure to the exception of Panama.

8 WORKPLACE STRESS: A COLLECTIVE CHALLENGE following psychosocial risks arising from work: financial problems Association, women and men report different reactions to stress, (including unemployment), conflicts (including mobbing, bullying both physically and mentally. They attempt to manage stress and and harassment), low control or low decision latitude, low social perceive their ability to do so in distinctly different ways. While support, high psychological demands, and long working hours.104 women are more likely to report physical symptoms associated For example, an Australian study found that seventeen per cent with stress, they manage better at communicating and connecting of suicides in the province of Victoria between 2000 and 2007 with others in their lives and these connections contribute to their were work-related.105 According to national public health statistics stress management strategies. Even if men and women report from Thailand, in 2007 the rate of suicide among people of similar average stress levels, women are more likely than men working age was 7 per 100,000 people which was higher than to report physical and emotional symptoms of stress and that the overall national rate of 5.95.106 In addition, the Assumption their stress levels are on the rise. When comparing women with Business Administration College (ABAC) conducted a survey each other, there also appear to be differences in the way that supported by the Thai Health Promotion Foundation in 2007. married and single women experience stress. Men appear more The survey found that stress levels have risen and almost ten per reluctant to believe that stress is having an impact on their own cent of Thai workers (from unskilled workers to office workers) health; they also put less emphasis on the need to manage their had contemplated suicide because of low life quality. Day-wage stress than women, have less confidence in psychologists, and workers were found to have lower levels of mental health (lower are less likely to employ strategies to make lifestyle and behaviour scores) than other groups of workers, perhaps because of their changes. However, men are more likely than women to report occupational insecurity and unreliable income.107 being diagnosed with the types of chronic physical illnesses that are often linked with high stress levels and unhealthy lifestyles and Some data on the incidence of work-related suicide can be behaviours. 114 These findings confirm previous studies in European obtained from figures related to workers’ compensation claims countries and alert on the need to take into account important (in those countries recognizing suicide as having an occupational gender differences in stress management.115 origin). For example, in Japan work-related suicide (known as karojisatsu: suicide due to overwork and stressful working Even if the rate of labour market participation by women has conditions) has become a social issue and has been recognized by increased enormously over the past century, according to the workers’ accident compensation insurance since the second the ILO overall the labour market participation rate of women half of the 1980s. It has been associated with long working hours, remains some twenty six per cent lower than that of men and heavy workloads, lack of job control, routine and repetitive tasks, the gender pay gap remains over twenty per cent, with no interpersonal conflicts, inadequate rewards, employment insecurity, evidence of any unambiguous or rapid reduction.116 In addition, and organizational problems.XIV According to the Japanese in most societies women continue to be mainly responsible for Ministry of Health, Labour and Welfare (MHLW) there has been domestic, unpaid work such as cooking, cleaning and caring an increasing trend in cases of karojisatsu in Japan. In 14 years, for children, and therefore they carry a double burden when between 1997 and 2011 the number of compensated cases of they are employed. Women are also largely represented among karojisatsu rose from 2 to 66.108 Furthermore, the White paper unpaid contributing family workers, such as those who work on Suicide Prevention in Japan (2012) states that work-related in a business establishment for a relative who lives in the same issues caused between seven point six and twelve point three per household as they do.117 Balancing responsibilities for paid and cent of suicides in 20-59 year-old men (more than double than unpaid work often leads to stress, depression and fatigue, and for Japanese women).109 In addition, in 2013 half of the causes can be particularly problematic when income is low and social of death for people in their 20s was suicide, with about forty per services and support are lacking. Psychosocial hazards that may cent of cases motivated by work-related depression and distress, be more frequent and specific to women include: (i) the double according to the Annual Health, Labour and Welfare Report for role they have to play at home and work; (ii) the gender roles of the Realization of a Society of Health and Longevity (2014) of the society and the influence of social expectations; (iii) the risk of Japanese MHLW.110 In the Republic of Korea, 23 work-related sexual harassment at work or domestic violence; and (iv) gender- suicides were compensated between 1999 and 2004,111 while based discrimination reflected in lower wages and higher job in France for the biennium 2010-2011 there were 149 claims requirements.118 reported, 43 of which were recognised and compensated.112 The economic crisis and recession have been accompanied by an increase in suicide rates. A study published in 2009 on the public health effect of economic crises examined the associations between changes in employment and mortality in 26 EU countries IMPACT ON PRODUCTIVITY between 1970 and 2007. The study found that for every one per cent increase in unemployment, there was an associated AND ECONOMIC COSTS OF zero point seventy-nine per cent increase in suicides by people under 65. Furthermore, a more than three per cent increase in WORK-RELATED STRESS AND unemployment was associated with a greater increase in suicides (four point forty-five per cent) and in deaths from alcohol abuse ASSOCIATED MENTAL HEALTH 113 (twenty-eight per cent) at ages lower than 65 years. DISORDERS The impact of work-related stress on workplace productivity and the broader economy is considerable. Work-related stress can severely impact workers’ general achievement levels in a THE GENDER DIMENSION negative way with respect to both efficiency and accuracy.119 Women and men respond to and manage stress in different ways. Studies investigating the impact of work-related stress on Most studies on gender and stress concern women. According to organizational outcomes have revealed a number of associated the Stress in America survey (2010) of the American Psychological forms of behaviour affecting productivity, competitiveness and the public image of the enterprise. For example, besides the impact on workers’ health and wellbeing, a poor psychosocial working environment contributing to work-related stress can result in XIV Beside suicide, death from overwork (karoshi) represents another important social issue, in Japan. Karoshi is not a pure medical term but a socio-medical term increased absenteeism and presenteeism, as well as reduced that refers to fatalities or associated work disability due to cardiovascular attacks motivation, satisfaction and commitment, along with a greater rate (such as brain strokes, myocardial infarction or acute cardiac failure) aggravated of staff turnover and intention to quit.120 All of the above can have a by heavy workload and long working hours. Karoshi is also recognized and negative impact in terms of human, social and financial costs. compensated by the national workers’ accident compensation insurance.

2. WHAT IS THE IMPACT OF STRESS IN THE WORKING POPULATION? 9 Absenteeism has a long research history, owing to its widespread At national level, Safe Work Australia estimated in 2008/2009 prevalence and its associated cost to enterprises and society, that work-related stress cost Australian society AU$5.3 billion while far fewer studies are available on presenteeism.121 Evidence annually. This figure include expenses resulting from disruption of shows that absenteeism is associated with work-related stress production and medical costs.131 In addition, depression problems and psychosocial hazards such as workload, job control, role cost Australian employers approximately AU$8 billion per year as conflict, effort-reward imbalance, quality of leadership, shift a result of sickness absence and presenteeism, and of that figure work, limited career progression, and social relationships at work AU$693 million is due to job strain and bullying.132 In Canada, a (including low social support and workplace violence, bullying, and study conducted in 2011 estimated that mental health problems discrimination).122 Scientific literature on presenteeism indicates cost employers about CA$20 billion annually.133 In France, the similar findings, highlighting that an increase in work-related total cost of job strain in 2007 was estimated as between €1.9 stress is associated with an increase in presenteeism, even and €3 billion, including costs related to healthcare (€124– greater than that for absenteeism.123 Organizational policies on 199 million), absenteeism (€826–1,284 million), loss of activity pay, sick leave, attendance control, downsizing, and permanency (€756–1,235 million) and loss of productivity due to premature in employment, as well as job design (such as job demands, death (€166–279 million).134 In Germany, the estimated annual adjustment latitude, ease of replacement and teamwork) have cost of job strain in 2008 was €29.2 billion (€9.9 billion in direct been suggested as factors fostering presenteeism. Other costs such as prevention, rehabilitation, maintenance treatment psychosocial hazards identified as predictors of presenteeism are and administration; and €19.3 billion in indirect costs such as time pressure, insufficient resources and unfavourable personal lost working years through incapacity, disability and premature financial situations.124 Finally, it should be noted that presenteeism death).135 In Spain, the direct health cost of mental and behavioural can in turn lead to burnout over time. In fact, exhaustion and disorders attributable to work was estimated at between €150 presenteeism were found to be reciprocal, suggesting that when and €372 million in 2010. In the same year, 2.78 million days were workers experience exhaustion, they mobilize compensation lost to sick leave caused by work-related mental illness, equivalent strategies through presenteeism, which ultimately increases their to a loss of €170.96 million.136 According to the latest estimates exhaustion.125 in the United Kingdom (UK), losses due to work-related stress, depression or anxiety amounted to the equivalent of 9.9 million Over the years, psychosocial hazards related to organizational days, representing forty-three per cent of all working days lost due outcomes, such as levels of job satisfaction, motivation, to ill-health during the period 2014/2015.137 A study conducted commitment and intention to quit have received much attention in 2007 by the Sainsbury Centre for Mental Health in the UK in the scientific literature, as they are considered indicators of estimated that the total annual cost to employers of mental health individual and organizational performance. Job satisfaction can disorders among their staff was nearly £26 billion, equivalent be an important factor influencing workers’ health and wellbeing, to £1,035 for every worker (£335 due to absenteeism, £605 to as well as their performance.126 Large-scale studies corroborate presenteeism and £95 to staff turnover).138 findings from smaller studies, showcasing the fact that job satisfaction is affected by the following psychosocial hazards: long working hours, job demands, lack of career advancement and promotion opportunities, poor relationships at work, emotional exhaustion, burnout, work-family conflict and exposure to bullying and harassment; it is also exacerbated by work-related stress.127 In addition, work-related stress and job dissatisfaction have also a negative impact on workers’ motivation and commitment, increasing their intention to quit. Evidence supports that increased intention to leave is related to work overload, high job demands, lack of job control, effort-reward imbalance, poor salary, perceived meaningfulness of the job, poor job relations and support, bullying, low organizational commitment and burnout.128 Conversely, supportive relationships have an indirect effect on reducing burnout and turnover intention through its effect on perceived stress, whereas job-relevant communication also has a direct effect on turnover intention.129 The related direct and indirect costs are only beginning to be quantified. Still, some developed countries assess the economic impact of work-related stress, associated behavioural patterns and mental health disorders. For example, in Europe the estimated cost of work-related depression is €617 billion a year, which includes the costs to employers of absenteeism and presenteeism (€272 billion), loss of productivity (€242 billion), healthcare costs (€63 billion) and social welfare costs in the form of disability benefit payments (€39 billion).130

10 WORKPLACE STRESS: A COLLECTIVE CHALLENGE environment, including the adaptation of work to the capabilities of workers so as to facilitate optimal physical and mental health 3. WHAT IS THE at work. The Promotional Framework for Occupational Safety and EXISTING LEGAL Health Convention, 2006 (No. 187) and its accompanying Recommendation (No. 197) complement the previous core standards and describe the requirements and functions of FRAMEWORK ON a national structure, relevant institutions and stakeholders responsible for implementing a national and enterprise level policy for safe and healthy working environments, as well as the steps WORK-RELATED to be taken to build and maintain a preventive safety and health culture at national level. Other International Labour Standards that can be pertinent in the STRESS AND MENTAL area of psychosocial risks and mental health are those related to equality of opportunity and treatment, working time and HEALTH AT WORK? night work.XVI

This section provides a summary of the legal approaches, at international, regional and national levels, addressing psychosocial REGIONAL STANDARDS risks, work-related stress and some related behavioural patterns such as psychological harassment. It comprises an overview of Few regional organizations have developed legally binding binding legal instruments on the prevention of psychosocial risks instruments covering psychosocial risks and the protection of and the protection of workers’ mental health; inclusion of work- workers’ mental health for their member States. related stress and mental disorders in national lists of occupational In Latin America, the Southern Common Market (MERCOSUR) diseases; non-binding standards on psychosocial risks and work- adopted in 1998 the Social and Labour Declaration,XVII which related stress; examples of framework agreements and collective includes provisions for health and safety at work, providing for agreements adopted by social partners; and the role of labour workers’ right to the protection of their physical and mental health, inspection in this area. and calls member States to formulate, implement and update policies and programmes on OSH, with a view to preventing occupational accidents and diseases.139 In 2004 the Andean Community adopted the Andean Instrument INTERNATIONAL LABOUR on Safety and Health at Work (Decision No. 584) establishing a legal framework for the protection of workers’ safety and health STANDARDS within the sub-region.XVIII The aim was to harmonize the labour laws in all the Andean Community countries starting with basic The core values reflected in ILO standards on occupational principles for reducing occupational risks. The Instrument defines safety and health are expressed in three main principles: (i) work working environment conditions as those elements, agents or should take place in a safe and healthy working environment; (ii) factors that have significant influence in the generation of risks to conditions of work should be consistent with workers’ wellbeing the safety and health of workers, including the organization and and human dignity; and (iii) work should offer real possibilities for management of work, along with ergonomic and psychosocial personal achievement, self-fulfilment and service to society.XV In factors. The Instrument also defines occupational health as the particular, the ILO core Convention on Occupational Safety and branch of public health aiming at the promotion and maintenance Health, 1981 (No.155) and its accompanying Recommendation of the highest possible degree of workers’ physical, mental and (No.164) provide for the adoption, implementation and review of a social wellbeing; the prevention of any harm to health caused by coherent national policy on OSH and measures for its application working conditions and risk factors; and the adaptation of the at national and workplace levels with the aim of protecting workers’ work to workers in accordance with their skills and abilities. It physical and mental health and wellbeing. The aim of the policy provides for member States to promote within their national OSH should be to prevent accidents and diseases arising out of, linked systems the improvement of safety and health at work, in order to with, or occurring during the course of work, by minimising, as far prevent harm to workers’ physical and mental integrity arising from, as is reasonably practicable, the causes of hazards inherent in the related to, or occurring during work. The Andean Instrument also working environment, so as to protect the physical and mental requires employers to develop comprehensive plans to prevent health of workers. The policy should also take into account the risks, including the adaptation of work to the abilities of workers, relationships between the material elements of work and the persons given their state of physical and mental health, taking into account who carry out or supervise the work, as well as the adaptation of ergonomics and other disciplines related to the different types of machinery, equipment, working time, organization of work and work psychosocial risk.140 processes to the physical and mental capacities of workers. In the EU, the Framework Directive on Safety and Health at Work The Occupational Health Services Convention, 1985 (No. 161) (89/391/EEC) governs the implementation of OSH within member and its accompanying Recommendation (No. 171) define the States. Even though the Directive does not refer explicitly to “work- role of occupational health services as multidisciplinary services related stress” or “psychosocial risks”, it provides for employers with essentially preventive and advisory functions, responsible to ensure workers’ health and safety in every aspect related to for assisting employers, workers, and their representatives work. It requires employers to adapt the work to the individual, in establishing and maintaining a safe and healthy working

XV International Labour Standards are legal instruments drawn up by ILO’s XVI See http://www.ilo.org/global/standards/subjects-covered-by-international-labour- constituents (governments, employers and workers) setting out basic principles standards/lang--en/index.htm for a comprehensive list of ILO Standards by subject.

and rights at work. They are either conventions, which are legally binding XVII international treaties that may be ratified by member States, or recommendations, The members of MERCOSUR are Argentina, Brazil, Paraguay and Uruguay. which serve as non-binding guidelines and in most cases complement relevant XVIII The current members of the Andean Community are Bolivia, Colombia, Ecuador and conventions. Peru; while Argentina, Brazil, Chile, Paraguay and Uruguay are associate members.

3. WHAT IS THE EXISTING LEGAL FRAMEWORK ON WORK-RELATED STRESS AND MENTAL HEALTH AT WORK? 11 especially as regards the design of workplaces, the choice of work Many other countries have successively incorporated provisions in equipment and the choice of working and production methods; these areas in their legislation. and to develop a coherent overall prevention policy which covers Some countries refer to the protection of mental health and technology, organization of work, working conditions, social wellbeing within the scope of OSH Acts and regulations (e.g. relations and the influence of factors related to the working Algeria, Argentina, Belize, Bolivia, Colombia, Costa Rica, Cuba, environment.141 A number of EU member States do not explicitly Haiti, and Venezuela) or within the objectives of OSH institutions mention psychosocial hazards or stress, keeping the text of their (e.g. Canada and the Dominican Republic). In a few countries OSH laws close to the EU Framework Directive (e.g. Luxembourg, the protection of mental health is included in the Constitution Poland, Romania, Slovenia and Spain); while others refer to the as a general duty of the State for all citizens (e.g. Lesotho) or as need to take psychosocial risks or mental health into consideration an individual’s right (e.g. Chile and Peru). A number of national when addressing OSH (e.g. Austria, Denmark, Estonia, Finland, legislations refer to the protection of mental health or psychosocial France, Greece, Italy, Norway, Slovakia and Sweden). The EU wellbeing in the definition of “health”, “disease” or “injury” in their Directive on the minimum safety and health requirements for Labour Codes or OSH laws (e.g. Angola, Antigua and Barbuda, work with display screen equipment (90/270/EEC) states that Australia, Bahamas, Dominican Republic, Ecuador, Guyana, “employers shall be obliged to perform an analysis of workstations Mauritius, New Zealand, Nicaragua, Philippines, Swaziland, in order to evaluate the safety and health conditions to which they Tanzania, Thailand, Trinidad and Tobago, and Venezuela) or within give rise for their workers, particularly as regards possible risks to the aims of the disciplines of occupational health or occupational eyesight, physical problems and problems of mental stress”.142 medicine (e.g. Bahrain, El Salvador, Nicaragua, Panama, Paraguay, The EU Directive on prevention from sharp injuries in the hospital Peru, and Thailand). and healthcare sector (2010/32/EC) implements the Framework Agreement on this matter signed by the social partners (annexed Certain countries also provide in their OSH legislation a detailed to the Directive).143 The Directive requires employers to ensure the legal definition of psychosocial hazards and risks (e.g. El Salvador, safety and health of workers in every aspect related to their work, Estonia, Mexico and Peru). For example, in Mexico the OSH Act including psychosocial factors and work organization. It envisages defines psychosocial risk factors (hazards) as those elements that employers will conduct a comprehensive risk assessment related to job functions, working hours, and exposure to traumatic and develop a coherent prevention policy, covering technology, events or acts of workplace violence, which can result in anxiety organization of work, working conditions, psychosocial factors and disorders, sleep disorders and severe stress conditions.148 the influence of other factors related to the working environment.144 According to the Estonia OSH Act, psychological hazards are Other EU Directives that can be relevant to the field of psychosocial monotonous work or work not corresponding to the abilities of a factors are those focusing on working time, equal treatment and worker, poor work organization, working alone for an extended discrimination. period of time, and other similar factors that may gradually cause changes in the mental state of a worker.149 Other national OSH regulations refer to psychosocial hazards as emerging risks (e.g. Ecuador and Niger), or within the general provisions as a subject for future research (e.g. Argentina, Cuba, and the United States). NATIONAL LEGISLATION Specific regulations on psychosocial risks are not very common, and Legal provisions covering psychosocial hazards and risks, work- only a few countries have drafted them; for example, the Belgian related stress and workers’ mental health and wellbeing can be Royal Decree on the prevention of psychosocial risks at work (2014) included in Labour Codes, OSH Laws, OSH Acts, specific OSH defines psychosocial risks, along with the preventive measures regulations, codes of practice, technical standards, decrees to be adopted, the role of the prevention and protection services, and collective agreements. It should be noted that reference and workers’ rights to participation.150 The Colombian Resolution to psychosocial hazards and risks or work-related stress has 2646 on risk assessment and management of psychosocial frequently been included in a non-unified and fragmented manner, hazards (2008) establishes rules and liabilities for the permanent in many national legal frameworks. identification, assessment, prevention, intervention and monitoring of exposure to psychosocial hazards and risks at work and for The Nordic countries have led the way in recognition of determining the origin of diseases caused by work-related stress.151 psychosocial risks in the workplace and development of relevant legislation. The Danish Working Environment Act (1977) was the In various countries national legislation provides for the protection first law covering aspects related to the psychosocial working of mental health and wellbeing of specific categories of workers. environment. In the same year Sweden adopted its Working For instance, a number of countries have specific requirements Environment Act which also included provisions concerning for young workers, promoting their mental or moral integrity and psychosocial factors at work. The Norwegian Working Environment development (e.g. Algeria, Angola, Botswana, Bulgaria, Burkina Act, also adopted in 1977, requires that work be organized to Faso, Central African Republic, Chile, Cuba, Ecuador, Haiti, provide workers the opportunity for professional and personal Jordan, Mauritius, Mozambique, Nicaragua, Peru, Portugal, development. In 1995 the Act incorporated a provision relating Somalia, South Africa, Tunisia, Turkmenistan, and Uruguay), as to bullying.145 The current Norwegian Working Environment Act well as for protecting pregnant workers from mental fatigue and (2005) includes specific requirements regarding the prevention job strain (e.g. Austria, Czech Republic, Estonia, Georgia, Italy, of psychosocial risks in the working environment in order to Luxembourg, Norway, and Romania). preserve workers’ integrity and dignity.146 In Finland specific A number of countries explicitly refer to mental health or provisions on the psychosocial working environment were psychosocial factors within the aims or the functions of OSH included in the Occupational Safety and Health Act in 2003. services or as part of workers’ health surveillance (e.g. Algeria, A number of requirements were introduced with this new Act Angola, Argentina, Costa Rica, Germany, Japan, Libya, Mexico, relating to psychosocial strain, violence, solitary work, bullying Namibia, Paraguay, Senegal, Venezuela, and Zambia). For and other inappropriate behaviour. In Iceland the current Working example, in Namibia OSH services’ functions include monitoring Environment Act was adopted in 1980. In 2003 provisions were of physical, chemical and biological hazards and psychological added to the Act, stipulating requirements to the effect that factors in the working environment which may affect workers’ employers should carry out systematic preventive measures health, including work methods and organization of work.152 including risk assessments of the psychosocial working Some countries make reference to mental health in relation to environment. In 2004 bullying and other inappropriate behaviour pre-employment medical examinations in order to ascertain that were also included in the Act.147 workers are psychologically fit for the type of work required (e.g. Argentina, Bahrain, Cuba, Colombia, Egypt, Oman, and Qatar).

12 WORKPLACE STRESS: A COLLECTIVE CHALLENGE EMPLOYERS’ RESPONSIBILITIES AND Workers’ rights to information and training are recognized in most countries; however, only a few specifically refer to psychosocial WORKERS’ RIGHTS risks, work-related stress or mental health as issues to be In several countries the protection of mental health and wellbeing covered (e.g. El Salvador, Niger, Rwanda and Venezuela). For is covered in OSH law as a worker’s right or as a general duty example, in Niger the Labour Code requests employers to raise of employers, including their responsibility for safe working awareness of emerging health risks (such as work-related stress, environments, working conditions and work organization (e.g. alcohol and drug consumption, and smoking), and to inform 161 Algeria, Angola, Benin, Burkina Faso, Bolivia, Costa Rica, Cuba, workers and provide them with psychological assistance. In Denmark, Equatorial Guinea, Eritrea, Estonia, Finland, Honduras, El Salvador, the employer must take the necessary measures to Japan, Republic of Korea, Mexico, Mozambique, Norway, Peru, prevent, identify, eliminate or reduce psychosocial risks, such Somalia, Venezuela and Zambia). For example, in Venezuela the as (a) minimizing the negative effects of monotonous, repetitive Labour Law establishes that work should take place in conditions work; (b) establishing means of fostering beneficial and respectful of safety and dignity to allow workers to develop their potential, labour relations and effective communication; (c) involving ensuring: (a) their physical, intellectual and moral development; workers in the implementation of changes in work organization; (b) training and knowledge-sharing in the social work process; (d) raising awareness of the causes and effects of violence and (c) time for rest and recreation; (d) a healthy work environment; sexual harassment; and (e) collecting proposals at all levels and (e) the protection of life, health and safety at work; and (f) the in all areas for controlling psychosocial risks. The employer has prevention of, and implementation of measures to avoid, any the responsibility for providing training and designing awareness- form of harassment.153 In the Labour Law of Burkina Faso, the raising programmes on violence and psychosocial risks, to employer is under an obligation to provide workers with working contribute to the establishment of mechanisms for investigation conditions that facilitate their normal physical, mental and social and early detection of this type of risks, as well as to the development, as well as the independence of their moral and development of an organizational culture based on the human 162 civic consciousness. To this end employers must allow workers being, so as to create a healthy working environment. enough free time for rest, training, recreation and social life.154 According to the OSH Act in the Republic of Korea, the employer is required to create a pleasant work environment that can reduce WORKPLACE VIOLENCE 155 workers’ physical fatigue and mental stress. The prevention and management of psychological harassment Some national legislation refers to the employer’s responsibility and violence at work were the first areas in this context in for the prevention and control of psychosocial risks, work- which public awareness of the impact on workers’ wellbeing related stress, mental fatigue, or psychological workload (e.g. stimulated development of legislation on corrective measures Bulgaria, Comoros, Dominican Republic, El Salvador, Mexico, and penalties.XIX Most of such legislation was developed in the Namibia, the Netherlands, Republic of Korea, Turkmenistan, and 1990s. A considerable number of countries addressed workplace Uruguay). For example, the new Mexican OSH Regulatory Act violence in Labour Codes, OSH Laws, specific regulations, codes (2014) requires the employer to take action on psychosocial risk of practice and guidelines, as well as in criminal law, in particular factors, including inter alia identification and analysis of those concerning reactive or protective actions and penalties. Bolivia jobs presenting psychosocial risk factors because of the nature represents a rare case in which the prohibition of any form of of the duties or working time; adoption of appropriate preventive work-related harassment is covered by the Constitution.163 measures to mitigate psychosocial risks; conduct of medical All the Nordic countries have both legislation and guidance for examinations for those workers exposed to psychosocial risks; managing workplace bullying. They also have legislation ensuring and provision of information on possible health disorders caused the individual’s right to a safe working environment, requiring 156 by exposure to psychosocial risk. the employer to prevent bullying from occurring and ensuring In addition, some national OSH laws explicitly require employers firm handling of bullying when a complaint is made.164 Sweden to carry out risk assessments of psychosocial hazards (e.g. was the first country to introduce anti-bullying and anti-mobbing Australia, Denmark, Germany, Hungary, Italy, Lithuania, Mexico, legislation in 1993, affording protection of workers from physical Peru, and Slovakia). For example, in Italy the OSH Act (Decree, and psychological harm.165 no.81 of 2008) requires employers to assess work-related stress In most countries with legislation on workplace violence, workers 157 as part of the risk assessment process; while in Lithuania, are protected from psychological or moral harassment and employers are required to evaluate psychosocial factors causing employers are restrained, directly or through their representatives, work-related stress and protecting workers from psychosocial from any offensive act that harms workers psychologically or 158 risks or minimising such risks as much as possible. morally (e.g. Bosnia and Herzegovina, Canada, Colombia, Some national legislation also incorporates provisions related Comoros, Denmark, Ecuador, Finland, Germany, Italy, Latvia, to coping behaviours. In some countries the prohibition of the Netherlands, Niger, Norway, Paraguay, Portugal, Rwanda, drug and alcohol consumption at work is covered by law (e.g. Seychelles, Slovenia, Sudan, Sweden, and United Kingdom). Angola, Benin, Bolivia, Chile, Congo, Haiti, and Niger), and most Many countries include protection from harassment on the countries forbid smoking in the workplace. In a few countries grounds of gender (e.g. Argentina, Bosnia and Herzegovina, OSH legislation provides for health promotion in the workplace. Bulgaria, Croatia, Cyprus, El Salvador, Greece, Hungary, Mexico, For example, in Oman, OSH regulations state that the workplace Norway, Pakistan, Romania, and Ukraine). In many cases, the must be supportive of general health to minimize unhealthy Labour Code provides also for disciplinary measures, including habits by promoting healthy food and physical activity; it includes employment termination (e.g. Colombia, Dominican Republic, prohibition of smoking and programmes that help workers to Guatemala, Honduras, Jordan, Morocco, Paraguay, South Africa, quit smoking; and enhancement of psychological health and and Tunisia). 159 social integration of psychologically unstable workers. In The EU Framework Agreement on Harassment and Violence Venezuela, the Labour Law includes in the functions of trade at Work (2007) aims at increasing the levels of awareness and unions and employers’ organizations the implementation of understanding of employers, workers and their representatives awareness-raising campaigns against corruption, abuse of drugs on these issues, and to provide them with an action-oriented and psychotropic substances, and other habits harmful to the framework for identification, management and prevention of these physical and mental health of workers.160 It has to be mentioned that legislation and collective agreements concerning substance abuse in the workplace (alcohol & drugs) do not always relate to the ultimate causes of such behaviours or to their prevention or XIX The first regulations on the matter often refer to psychological harassment as “moral” owing to the ethical perspective and legal terminology. Psychological the role that work organization can play. harassment and moral harassment are used synonymously by some scholars.

3. WHAT IS THE EXISTING LEGAL FRAMEWORK ON WORK-RELATED STRESS AND MENTAL HEALTH AT WORK? 13 problems. In 2010, the European Social partners also adopted In the Americas, a number of countries include in their lists of Multi-Sectoral Guidelines to tackle third-party violence and occupational diseases mental health diseases or some specific harassment related to work.166 related disorders; for example, Argentina (PTSD, neurosis, paranoia, and psychotic depression); Brazil (stress, PTSD, sleep disorders and burnout); Chile (professional disabling neurosis with different clinical manifestations, such as adjustment disorder, anxiety disorder, reactive depression, somatization disorder and INCLUSION OF WORK- chronic pain, and work-related neurosis involving the risk of mental strain); Colombia (pathologies caused by work-related stress, RELATED STRESS AND such as states of anxiety and depression, non-organic sleep disorders, burnout, PTSD, as well as myocardial infarction, arterial MENTAL DISORDERS hypertension, ischemia, peptic ulcer, gastric ulcer, irritable bowel syndrome, etc.); Mexico (neurosis); Nicaragua (neurosis, insomnia and fatigue); and Venezuela (work-related stress, work-related IN NATIONAL LISTS OF fatigue, burnout, mobbing syndrome and non-organic sleep disorders). Ecuador and Paraguay adopted the ILO semi-open OCCUPATIONAL DISEASES list of occupational diseases, recognizing mental and behavioural A national list of occupational diseases (together with a set of disorders, PTSD, and other mental or behavioural disorders well-established diagnostic criteria) can facilitate their recognition where a direct link is established between exposure to the risk and compensation. In the majority of countries the notification of factors arising from work activities and the mental and behavioural occupational diseases is regulated, often using international or disorder contracted by the worker. regional standards as a reference. In the Asia-Pacific region, the Republic of Korea and Malaysia ILO Convention No. 155 is complemented by the include mental disorders in their national lists of occupational Recommendation on the List of Occupational Diseases, 2002 diseases; while the Workers’ Compensation Law in New Zealand (No.194), which provides for regular review and updating of the covers mental injury caused by sexual violation. In Singapore, ILO list of occupational diseases contained in the Annex of the compensation has been claimed for PTSD, as well as certain Recommendation through tripartite meetings of experts. The ILO cases of heart attack associated with long working hours or work- list, updated in 2010, covers mental and behavioural disorders, related stress. In Japan, workers compensation for work-related including post-traumatic stress disorders (PTSD), thereby creating mental health disorders has been provided since 1999, and the for the first time the possibility of other such diseases being Labour Law has incorporated criteria for the recognition of death recognized as having an occupational origin if a direct link is from overwork (karoshi) and work-related suicide (karojisatsu) for established scientifically (or determined by methods appropriate compensation to the family of a worker who dies in this way.169 to national conditions and practice) between the exposure to risk Most countries in Africa and the Arab States do not include stress factors at the workplace and the mental disorder. or associated mental disorders in their national lists of occupational The ILO periodically revises its list of occupational diseases in diseases. However, workers’ compensation laws sometimes order to keep abreast with international development and meet cover some mental disorders, as in Nigeria where mental stress the increased demand for an international reference reflecting not resulting from an injury (but defined with specific criteria) is today’s world of work. This list facilitates identification of suspected compensated for; and in the Syrian Arab Republic, where the occupational diseases and helps countries in prevention, reporting, Decision on stress as a cause for work injury allows social security recording and compensation of affected workers. A regular review benefit entitlement for occupational injuries caused by stress, both and updating process is of particular value. The “open items” in mental and physical.170 the list, which allow for recognition of new diseases, rely on active contributions by hygienists and physicians, as well as employers, workers and national authorities. The ILO has provided assistance on shaping and updating national lists of occupational diseases to several countries through technical advisory and consultation NON-BINDING TECHNICAL services (e.g. Belgium, Canada, China, Egypt, Germany, Grenada, India, Italy, Mexico, and United Kingdom), and at regional level to STANDARDS ON the EU and the Caribbean Community (CARICOM). EU countries tend to follow the European schedule of PSYCHOSOCIAL RISKS occupational diseases provided for under the European Commission Recommendation No. 2003/670/EC. A report PREVENTION AND published by the European Commission in 2013 reviews the situation concerning occupational diseases in EU member MANAGEMENT States and EEA/EFTA States.167 Mental and stress-related Non-binding technical standards, codes of conduct and protocols disorders are included in national lists of occupational diseases recognized by governments can also play an important role in from the following EU countries: Denmark (PTSD); Hungary promoting harmonised action in this field. In many countries (diseases due to psychosocial factors); Italy (PTSD, and chronic authorities have implemented non-binding solutions to address adjustment disorders such as anxiety, depression, behaviour or psychosocial risks, including technical standards, voluntary affective disorders); Latvia (diseases caused by overload, and guidelines, codes of practice and other guidance on how to apply psychoneurosis); Lithuania (occupational diseases due to stress); general OSH principles in this area.XX Some authorities have opted the Netherlands (occupational stress related disorder and burnout, to describe methods of carrying out assessment and corrective job related depression, PTSD, alcohol addiction); Romania measures rather than to impose them. Although non-binding (psychoneurosis caused by long-term care of psychopathic people national standards on psychosocial risks and work-related stress in psychiatric units); while in Finland mental and behavioural are not so frequent, globally the following merit reference. disorders are covered in the national disability registers (F:ICD-10) and its open system. Work-related mental disorders are also compensated in the Swedish open system and through the complementary system in some other EU member States, such as Belgium, Denmark (for stress-related disorders other than PTSD), XX 168 Section 4 of this report includes an overview of assessment and management and France. tools developed both by national authorities and the Academia.

14 WORKPLACE STRESS: A COLLECTIVE CHALLENGE The British Publicly Available Specification (PAS) for psychosocial part of an integrated stress policy encompassing both preventive risk management: PAS 1010: 2011. Guidance on the management and responsive measures. The responsibility for determining the of psychosocial risks in the workplace was developed by the British appropriate measures rests with the employer, but these measures Standards Institution (BSI). This PAS aims at helping organizations should be carried out with the participation and collaboration of and enterprises: (i) to establish a strategy on and process for workers or their representatives. The Agreement represented a psychosocial risk management in order to eliminate or minimize starting point for a related social dialogue at EU level in five sectors: risks to personnel and other interested parties who could be education, central government administration, private security, exposed to psychosocial hazards associated with its activities; (ii) construction and electricity. to implement, maintain and continually improve the psychosocial In line with the framework agreement, national level agreements risk management process and related practices; (iii) to assure its setting a framework for negotiations on work-related stress conformity with its stated OSH and psychosocial risk policy.171 and psychosocial risks can be found in several EU countries. The Canadian National Standard on Psychological Health & For example, in Luxembourg and the Netherlands a tripartite Safety in the Workplace Prevention, Promotion, and Guidance comprehensive action-oriented framework based on the to Staged Implementation (CAN/CSA-Z1003-13/BNQ 9700- Agreement on Work-related Stress was adopted as a 803/2013) was published in 2013 by the CSA Group and the recommendation for negotiations at enterprise level. Finnish Bureau de Normalisation du Québec in collaboration with the and Swedish social partners agreed on joint guidelines for Mental Health Commission of Canada. This is the first national bargaining or other joint activities on these issues at sectoral and standard that targets psychological health and safety in the enterprise levels. In Spain, the most representative trade unions workplace and is auditable, as compared to the PAS1010 which and employers’ organizations included work-related stress in the is only a guidance standard. The Canadian Standard aligns with Inter-confederation Agreements on Collective Bargaining, (AINC, other existing standards.XXI A unique aspect of this Standard is the 2005 and 2007), providing recommendations and priorities to inclusion of several annexes designed to assist with developing the signatory member organizations for use during collective and implementing its key components. Implementation models, bargaining.173 scenarios for small and large enterprises, an audit tool, and several Collective agreements at national level, establishing rights and other resources and references are provided.172 obligations for the signatory parties and their members, have also been concluded in Denmark (public sector); France (banking sector, electricity and gas, telecommunications, social economy, oil industry, pharmaceutical industry and agricultural cooperatives); Greece (cross-industry); Italy (inter-confederation); Sweden SOCIAL PARTNERS’ (municipal sector) and Romania (cross-industry). Belgian social partners adopted a cross-industry collective labour agreement AGREEMENTS within the National Labour Council on Managing Prevention According to the ILO, legal provisions include, in addition to laws and of Stress caused by Work (CCT/CAO no.72, 1999) before the 174 regulations, arbitration awards and collective agreements on which EU Agreement on Work-related Stress entered into force. In the force of law is conferred (Labour Inspection Convention, 1947, Germany, a sectoral collective agreement for private and public No. 81; Art. 27). The ILO Collective Agreements Recommendation, banks included a joint declaration calling on enterprises to 1951 (No. 91) defines collective agreements as all agreements in introduce measures to reduce mental strain, including realistic 175 writing on working conditions and terms of employment concluded objectives, autonomy and a comprehensive risk analysis (2010). between, on the one hand, an employer, a group of employers or France provides a good example of implementation of a work- one or more employers’ organizations, and, on the other hand, one related stress framework through social dialogue. In July 2008 or more representative workers’ organizations or, in the absence of all French social partners signed the national inter-professional such organizations, the representatives of the workers duly elected agreement on work-related stress, which was extended in and authorized by them in accordance with national laws and 2009. This agreement, which followed heightened attention to regulations. Collective agreements respect minimum standards set several worker suicides in the car industry in 2007, contributed out in national legislation and complement them or go beyond for to increasing collective bargaining in the country. The agreement the benefit of workers represented in the negotiations. Therefore, defined the concept of stress and required employers to decide collective agreements can only improve on the requirements on appropriate measures to prevent it. In 2013 the social partners established in the law of the country; never can they diminish the signed an Agreement on the Quality of Working Life.176 binding obligations of employers and workers under those collective agreements. At EU level, actions taken by social partners within the European Social Dialogue Framework have played a significant role in recognizing the relevance of psychosocial issues and work-related LABOUR INSPECTION stress over the past years, concluding a number of agreements According to ILO Labour Inspection Convention, 1947 (No. 81), (ratified by the Council of Ministers and now part of European the main functions of the system of labour inspection should be: legislation) covering such aspects as parental leave (1996), part- (i) to secure the enforcement of the legal provisions relating to time work (1997) and fixed-term contracts (1999). The social conditions of work and the protection of workers while engaged partners have also concluded framework agreements on telework in their work; and (ii) to supply technical information and advice to (2002), work-related stress (2004), harassment and violence at employers and workers concerning the most effective means of work (2007), and third-party violence and harassment related to complying with the legal provisions. These activities can be either work (2010). proactive or reactive. The first are initiated by the inspectorates According to the EU Framework Agreement on Work-related with preventive objectives and are mainly informational, educational Stress, factors causing work-related stress may be addressed and related to monitoring inputs regarding protective and within an overall process of risk assessment. Measures can be preventive measures that should be carried out by the employer. collective, individual or both. They can be introduced in the form Reactive activities focus on specific claims, alerts or problems of specific measures targeted at identifying stress factors or as that should be addressed by the inspectors as early as possible, including investigations of complaints, work-related injuries and other events. Labour inspectorates can receive explicit XXI I.e. BNQ 9700-800/3008 Prevention, Promotion and Organizational Practices complaints about psychosocial risks, particularly with regard to Contributing to Health in the Workplace, CAN/CSA-Z1000-06 (R2011) lack of assessment or the measures to prevent or reduce them, Occupational health and safety management.

3. WHAT IS THE EXISTING LEGAL FRAMEWORK ON WORK-RELATED STRESS AND MENTAL HEALTH AT WORK? 15 where relevant provisions are reflected in national law. However it occupational stress, fatigue, cognitive issues in design, safety is also not unusual to receive complaints which implicitly involve culture, and safety behaviour.181 these risks, such as those relating to violence, fatigue, working In Austria the changes in legislation on psychosocial risks were time, work overload, frequent changes, bad atmosphere or an accompanied by a guide to help labour inspectors evaluate offensive environment. Reactive inspection can be initiated by whether risk assessments and preventive actions have been other exceptional events such as worker suicides, a high level of carried out correctly, describing what labour inspectors are absenteeism or disputes, or other alerts or notices addressed to expected to monitor and what support they are expected to the labour inspectorate. In all these cases it is also appropriate supply, as well as providing overview tables and a catalogue a preventive approach to psychosocial risks. Inspectors should of criteria for assessing such risks.182 In France, the labour check the risk assessment and management measures adopted inspectorate has designed several checklists to help inspectors in by the employer in order to eliminate or mitigate the risks identified the identification of psychosocial risks in the workplace, collecting and avoid future occurrences.177 potential indicators of stress such as the number of accidents, Labour inspectorates and OSH Authorities have increasingly the amount of sick leave, training, overtime, shifts and working developed guidelines, tools and campaigns on psychosocial day changes, the frequency of disciplinary measures, complaints risk assessment for labour inspectors. At EU level, the Senior or requests, etc.183 In Germany, the Federal States Committee Labour Inspectors’ Committee (SLIC) promoted a campaign on for Occupational Safety and Health (LASI), which coordinates psychosocial risks in 2012, developing a toolkit for psychosocial the labour inspection policies of the federal states (Länder), has risk assessment that was used during inspections in 26 EU adopted general guidelines on psychosocial risks. These include member States and Iceland.XXII During the campaign a total of a model for testing the suitability of risk assessments carried out 13,508 inspections were made, particularly in the health sector by enterprises through a checklist under three main headings: (i) including social care (private and public), in the service sector (e.g. the content of the work and tasks; (ii) the organization of work; (iii) hotels and restaurants), and in the transport sector. social relations. In addition, the inspector is also required to analyse the indicators of potential causes of stress, such as the rate of At national level, the Nordic countries were among the first to absenteeism, the evidence from working processes (errors and include psychosocial factors in risk assessments of working complaints), the health and wellbeing of workers (alcohol problems, conditions conducted by the labour inspectorates. In Denmark, irritability, layoffs, etc.) and the social climate (conflict, harassment, the Danish Working Environment Authority (DWEA) in charge of violence).184 In the Netherlands, labour inspection on psychosocial ensuring compliance with OSH legislation has been carrying out risks is based on direct verification of psychosocial risks in the inspections focusing on the psychosocial working environment workplace by a specialized inspector. This verification is done since the early 1990s. Within a broad inspection campaign, using a basic questionnaire of 12 questions concerning symptoms the DWEA carried out a programme of special intensified of work-related stress, or another more advanced method which inspections, targeting enterprises in sectors exposed to potentially includes 24 questions on stress symptoms, 14 on psychosocial significant health and safety challenges, focusing on ergonomic risks, 21 on health problems and 2 on absenteeism.185 In Spain, and psychosocial risks. The DWEA also developed 24 sectoral a Code of Practice for the Labour Inspectors on Bullying and guidance tools to support inspectors in risk assessments of Violence at Work (69/2009) provides for specific action for psychosocial hazards, in order to standardise their approach.178 addressing harassment and violence in workplaces.186 In the UK, In Finland, qualified inspectors perform workplace inspections the inspection of psychosocial risks is carried out in a preventive following the Valmeri questionnaire, which covers psychosocial and proactive way, focusing on those sectors considered to risks such as the pace of work or workload that exceeds a involve high level of work-related stress (e.g. healthcare, public worker’s ability, training and information on the tasks performed, administration, education and the financial sector). To help assistance and support, aspects such as violence and harassment, inspectors perform their evaluation of psychosocial risks, the whether worker’s opinion is taken into account, and so forth.179 Health and Safety Executive (HSE) has developed the Inspection In Norway, the labour inspectorate has published a brochure on Pack on Work-related Stress and other materials describing work-related stress in cooperation with social partners, as well as the needs of the inspectors in every phase of the stress risk guidelines on Organizing and arranging work and the workplace management process, along with a final indicator of the situation of which also address work-related stress. Furthermore, in Denmark, the enterprise in relation to stress management.187 Finland, Norway and Sweden all newly-employed inspectors must complete basic introductory training (including theory and practice) on the psychosocial working environment.180 In recent years several labour inspectorates from other countries have developed guidance and models to help inspectors handle psychosocial risks. For example, in Australia the jurisdiction of Queensland has since 2004 included psychosocial risks in the labour inspection strategy. The initial focus was primarily reactive, developing procedures in response to harassment complaints. In 2006 psychosocial inspectors sought to combat the perception that psychosocial issues concerned mainly harassment, by developing a programme to address workplace stress. Psychosocial inspectors developed four information sheets on occupational stress as a tool for inspectors in the field. They also developed a model covering eight risk factors to screen reported stress incidents, along with a campaign to raise awareness on stress in the public sector; the purpose was to educate organizations on notification of stress incidents, and to develop their capacity to address stress in the workplace.XXIII More recently, the focus of inspectorate activity related to psychosocial risks was broadened to six general areas: workplace harassment,

XXII The report and the webpage of the 2012 campaign are available at https:// circabc.europa.eu/faces/jsp/extension/wai/navigation/container.jsp XXIII The model was based on work done by the UK Health and Safety Executive.

16 WORKPLACE STRESS: A COLLECTIVE CHALLENGE report reference should also be made to the code of practice on Management of alcohol and drug related issues in the workplace 4. STRATEGIES FOR and the adaptation and implementation of model programmes for the prevention of drug and alcohol abuse at national and enterprise levels through technical cooperation activities, as part of a broader THE PREVENTION health promotion strategy that supports the management of psychosocial hazards and risks and the prevention of work-related AND MANAGEMENT stress as an integral part of the OSH strategy.190 In addition to the ILO a number of international organizations such as the World Health Organization (WHO), the International OF PSYCHOSOCIAL Social Security Association (ISSA), the Organization for Economic Co-operation and Development (OECD), the World Bank and the World Economic Forum (WEF) have been active in the prevention HAZARDS AND and management of psychosocial hazards and the promotion of mental health at work through research and advocacy, including RISKS the development and implementation of specific initiatives. The WHO has contributed to the prevention of psychosocial risks through the publication of research, guidelines, tools and other resources. The work of the WHO on occupational health This section summarises most relevant initiatives, strategies is governed by the Global Plan of Action on Workers’ Health and actions on the prevention of work-related stress and the 2008-2017. The plan specifies actions “to protect and promote promotion of workers’ mental health. These have been developed health at the workplace”, and states that “the assessment and by different social actors including international organizations, management of health risks at the workplace should be improved regional institutions, national authorities, social partners, and OSH by defining essential interventions for prevention and control of professionals’ networks and associations. Several international mechanical, physical, chemical, biological and psychosocial risks organizations and regional institutions have included protection of in the working environment”.191 In April 2010, the WHO launched mental health in their agenda. the Global Framework for Healthy Workplaces, aimed at providing guidance on protection and promotion of the health, safety and A number of measuring tools (mainly questionnaire-based) have wellbeing of all workers and the sustainability of the workplace.192 been developed, aiming at the evaluation of psychosocial risks and According to the framework, the psychosocial work environment the levels of stress, both individual and collective (a list is available includes the organizational culture as well as attitudes, values, in Annex 1, Table 1.1). A broad range of management tools beliefs and daily practices in the workplace that affect the mental (including guidelines, on-line platforms, information sheets and and physical wellbeing of workers.193 The WHO has also developed other resources) have been developed to help both employers and relevant guidance on how to address psychosocial risks and work- workers in the prevention and management of work-related stress related stress through a number of publications, such as Work (a list of such tools is provided in Annex 1, Table 1.2). organization and stress (2003), Raising awareness to psychological harassment at work (2003), and Raising Awareness of Stress at Work in Developing Countries: A modern hazard in a traditional working environment (2007); and it supported the development of PRIMA-EF: Guidance on the European Framework for INTERNATIONAL Psychosocial Risk Management – A Resource for Employers and Worker Representatives (2008). In 2008 WHO launched the Mental ORGANIZATIONS Health Gap Action Programme (mhGAP) to address the lack of The prevention of psychosocial risks and work-related stress is care for people suffering from mental, neurological, and substance an important aspect of the ILO’s primary goal of workplace health use disorders, especially in low and middle income countries. In th promotion. ILO action in this field is carried out at national and 2013 the 66 World Health Assembly adopted the Comprehensive enterprise levels, developing essential tools which can be used Mental Health Action Plan 2013–2020, with the aims of: (i) by governments, employers, and workers to establish sound strengthening effective leadership and governance in relation OSH practices in order to maximize the impact of supporting to mental health; (ii) providing comprehensive, integrated and ILO’s member States. The ILO developed two complementary responsive mental health and social care services in community- tools for addressing mental health concerns in the workplace. based settings; (iii) implementing strategies for promotion and The Stress prevention at work checkpoints is an ergonomic tool prevention in mental health; and (iv) strengthening information 194 based on good practice, with which to audit and intervene by systems, evidence and research on mental health. means of a checklist and a set of guidelines focusing on workplace Proactive and preventive social security is one of the pillars of improvements for the prevention of psychosocial risks and work- the vision of ISSA. It recognizes that while prevention efforts related stress.188 The training package SOLVE: Integrating health over recent decades have resulted in many positive outcomes, promotion into workplace policies focuses on promoting health numerous challenges to workers’ health remain, such as the and wellbeing at work through OSH policy design and action to growing prevalence of psychosocial factors which are increasing offer an integrated response addressing the following areas and the complexity of prevention, calling for a more holistic approach their interactions: (i) psychosocial health (stress, psychological by social security institutions in promoting health and safety.195 and physical violence, economic stress); (ii) potential addictions and their effects on the workplace (tobacco consumption and The OECD recognizes that tackling mental ill-health in the working exposure to second-hand smoke, alcohol and drug consumption); population is a key issue for successful labour market and social and (iii) lifestyle habits (adequate nutrition, exercise or physical policies in OECD countries. The OECD Mental Health and Work activity, healthy sleep, prevention of HIV and AIDS).189 This training Project examined how broader challenges concerning mental tool is part of a programme implemented in different regions health at work have been tackled in the areas of education, of the world in collaboration with ILO constituents, NGOs and health, social and labour market policies in a number of OECD Universities. The programme has provided an important stimulus countries. The report Sick on the Job: Myths and Realities about for action at workplace and national levels, particularly through Mental Health and Work (2012) estimated the total cost of mental the close involvement of national governments and employers’ illness to be around three point five per cent of GDP in OECD and workers’ representative organizations. In the context of this countries and highlighted the need to keep people with mental

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS 17 ill-health in employment or bringing those outside the labour everyone to enjoy the highest attainable standard of physical and market back into it. According to the report, people with mild to mental health.XXIV It also states that every worker has the right to moderate disorders, such as anxiety or depression, are twice enjoy just and favourable conditions of work (including appropriate as likely to be unemployed, and also run a much higher risk of remuneration, working hours, rest and holidays, preservation of living in poverty and social marginalisation. OECD governments occupational health and safety, non-discrimination between men increasingly recognise that tackling the mental ill-health of the and women, and the protection of women, young workers and working population is becoming a key issue in labour market and disabled persons in the workplace).200 social policies.196 The report (part of the OECD Mental Health at Work series) is complemented by Mental Health at work country In the Asia-Pacific region, the Association of Southeast Asian reports (Austria, Belgium, Denmark, the Netherlands, Norway, Nations (ASEAN) adopted the Regional Action Plan on Healthy Sweden, Switzerland, and United Kingdom) and the interregional ASEAN Lifestyles (2002-2020) with the objective that ASEAN report Fit Mind, Fit Job: From Evidence to Practice in Mental Health citizens lead healthy lifestyles consistent with their values, beliefs and Work (2015). Other relevant OECD documents on this topic and culture in supportive environments. The strategies provided include the working paper on Mental Health and Work: Achieving in the Action Plan include strengthening the contribution of well-integrated policies and service delivery (2014) and the report health services, schools and workplaces in educating on healthy on Mental Health Policy Framework (2015) adopted by the OECD behaviour linking various activities of everyday living such as High-Level Policy Forum on Mental Health and Work. eating and drinking, physical activity, use of tobacco, alcohol and substance abuse, sexual behaviour, coping with stress, self-care, The World Bank includes among its areas of work the working, caring for others, and the quality and safety of the home, enhancement, awareness and understanding of mental and workplace and other environments. The Programme of Work on psychosocial health as development concerns. Its efforts are Promoting Healthy ASEAN Lifestyles calls member countries, in focused on ensuring that mental and psychosocial health are conjunction with appropriate partners, to take immediate action incorporated into operations within the development of more on priority policy areas including mental health and lifestyles, long-term policies, strategies, plans and resources to ensure collaborating in such a way as to providing environments that sustainability. The World Development Report 2015 Mind, Society promote social participation, minimize discrimination, and enhance and Behaviour aims at guiding researchers and practitioners economic opportunities, work settings and lifestyles, as well as who can support the advancement of a new set of development promoting the adoption of healthy workplace initiatives.201 The approaches based on broader consideration of psychological and South Asian Association for Regional Cooperation (SAARC) social influences.197 adopted the Delhi Declaration on Public Health Challenges (2015). Signing the Declaration, Health Ministers of the member States The WEF is an independent international organization promoting agreed to cooperate in combating mental disorders through a public-private cooperation and a platform for dialogue between multi-faceted approach.202 business, governments and civil society leaders. The WEF’s Global Agenda Council on Wellbeing and Mental Health plans to include In the Americas, the Organization of American States (OAS) mental illness in health and development agendas at global level adopted the Declaration of Commitment of Port of Spain by raising awareness on the importance, prevalence and burden Securing Our Citizens’ Future by Promoting Human Prosperity, of mental disorders; making the business case for positive mental Energy Security and Environmental Sustainability (2009).203 health and wellbeing for business and society; and reporting on This Declaration reaffirmed OAS countries’ commitment to the progress in the annual reports. In addition, the WEF produces ILO Declaration on Fundamental Principles and Rights at Work a series of research reports on several topics, including mental to promote decent work and to enforce national labour laws health, working conditions, gender equality, and others.198 with a view to providing adequate working conditions and safe and healthy workplaces, free from violence, harassment and discrimination.204 OAS Ministers of Labour adopted the Declaration of Medellin (2013) in which they committed to strengthening tripartite national strategies on occupational health so as to foster REGIONAL ORGANIZATIONS a culture of prevention and develop workers’ health programmes in the region. These programmes are aimed at helping countries AND INSTITUTIONS respond better to relevant challenges in the workplace, including the impact of substance addiction and non-communicable A number of regional organizations have been established to foster diseases such as cancer, diabetes, hypertension and mental health cooperation and political and economic integration or dialogue disorders in workers.205 The Caribbean Community (CARICOM) between governments in a particular geographical area. Some established the Caribbean Cooperation in Health Initiative (1984) have adopted policies related to promotion of mental health and to optimize utilization of resources, promote technical cooperation wellbeing and prevention of stress and related disorders, with the among member countries, and develop and secure funding for the aim of integrating or coordinating national activities at regional level. implementation of projects in priority health areas. The Caribbean On the African continent, the Southern African Development Cooperation in Health Phase III (2009-2015) sets the direction and Community (SADC) adopted the Protocol on Health (2004), goals for public health for that period and includes mental health 206 according to which member States should coordinate efforts to as a priority area. The strategy for improving and maintaining prevent diseases and promote wellbeing, implementing policies the mental health of the Caribbean population focuses on the and providing guidelines on health promotion and education, development of legislation, a regional mental health policy and healthy lifestyle and reduction of substance abuse. It also calls for action plan, the reform of mental health services, the management the development of legislation on mental health, regional training and care of mentally ill people including substance abusers, public guidelines and the integration of mental health services into primary information, education and communication. The Pan American healthcare, along with provision of proper treatment and care Health Organization (PAHO) Plan of Action on Mental Health (2015 XXV that respects the dignity and human rights of mentally ill persons, to 2020) is guiding mental health interventions in the Americas. development of supportive community care services and facilities, The objectives are promotion of mental wellbeing, prevention and cost-effective and culture-specific mental health research.199 of mental and substance-related disorders, provision of care, The Executive Board of Health Ministers of the Cooperation Council for the Arab States of the Gulf (GCC) developed a number of technical programmes, covering mental health, occupational XXIV A first version of the Charter was created in 1994, but no State ratified it; it was then updated in 2004 and came into force in 2008 when seven of the member health, tobacco control and prevention of non-communicable countries of the League of Arab States ratified it. diseases. In addition, the League of Arab States adopted in 2004 XXV PAHO is the specialized health agency of the Inter-American System and serves the Arab Charter on Human Rights which recognizes the right of as the Regional Office of the WHO for the Americas.

18 WORKPLACE STRESS: A COLLECTIVE CHALLENGE enhancement of rehabilitation, and an emphasis on recovery, (2002). EU-OSHA in collaboration with Eurofound also published along with promotion of the human rights of persons with mental the report Psychosocial risks in Europe: Prevalence and strategies and substance use disorders with the aim of reducing morbidity, for prevention (2014). Finally, the 2014-15 Healthy Workplaces disability and mortality. Although the Plan is focused on the health campaign organized by EU-OSHA was on the management of systems, it recognises the role of other sectors as crucial to stress, providing support and guidance for workers and employers promoting and protecting mental health.207 in managing psychosocial risks. The EU has also developed a number of relevant initiatives such as Within Europe, other regional organizations have developed the European Pact for Mental Health and Wellbeing (2008) and the relevant initiatives on psychosocial risks. For example, the Nordic related European Parliament Resolution on Mental Health (2009). Council, through the Nordic Council of Ministers, launched a The first of these recognized that mental health and wellbeing are project in 1994 to improve the scientific quality and comparability key resources for achieving the objectives of the Lisbon strategy of data relating to the psychological, social and organizational work in terms of growth and jobs, social cohesion and sustainable environment.XXVI The project team was given the task of developing development. One of the five priorities of the Pact is Mental Health and testing the General Nordic Questionnaire (QPSNordic) in Workplace Settings.208 The Resolution called on member States encompassing the most fundamental psychological and social to encourage research on working conditions which may increase factors at work.211 the incidence of mental illness, particularly among women; it also calls on employers to promote a healthy working climate, paying The NEW OSH ERA Consortium (an association of more than attention to work-related stress, the underlying causes of mental twenty funding organizations and European research institutes in disorders in the workplace, and to tackle those causes. Finally it the field of OSH) developed the PSYRES (psychological health and calls for the Commission to require businesses and public bodies wellbeing in restructuring: key effects and mechanisms) project. to publish an annual report on their policy and activities carried out PSYRES’s outputs include national information (e.g. labour market for the mental health of their workers, on the same basis as they systems, facts and figures); datasets and analyses, and a survey report on physical health and safety at work.209 tool; a guidebook, Steps towards sound change – initiatives for ensuring employee wellbeing during restructuring; and two The EC 6th Framework Programme of the EU Commission funded factsheets including key facts on restructuring, along with guidance a collaborative project, for the development of a European on how to manage restructuring so as to maintain workers’ framework for psychosocial risk management with a special wellbeing.212 focus on work-related stress and workplace violence (including harassment, bullying and mobbing). The Psychosocial Risk Management – European Excellence Framework (PRIMA-EF) was designed by a Consortium of partner institutions in 2011.210 It was the first project in this area to be introduced regionally. It includes NATIONAL STRATEGIES AND a virtual learning training programme intended to offer guidance on good practice in assessing and managing psychosocial risks at INITIATIVES work for human resource managers and specialists, occupational health and safety specialists, managers and owners of small and Over the past decade, besides the development of legal medium-sized enterprises (SMEs), and workers’ representatives. frameworks, many countries have designed national strategies including the prevention of psychosocial risks and work- The EU has several agencies, institutes and committees working related stress. In addition, national authorities have often set up on OSH. The European Foundation for the Improvement of Living commissions or committees, or have engaged research institutes and Working Conditions (Eurofound) is a tripartite EU Agency, to develop a range of initiatives to address these issues, from the role of which is to provide knowledge in the area of social scientific research to guidelines, tools, training and awareness- and work-related policies. Eurofound runs two regular surveys raising activities.XXVII on working life issues: the European Working Conditions Survey (EWCS) and the European Company Survey (ECS). The topics covered include employment status, working time duration and organization, work organization, learning and training, physical STRATEGIES and psychosocial risk factors, health and safety, work-life balance, In several countries, governments have explicitly included the workers’ participation, earnings and financial security. The prevention and management of psychosocial hazards and risks European Agency for Safety and Health at Work (EU-OSHA) is within their OSH national strategy. Often psychosocial risks or the EU information agency for OSH. In 2009, EU-OSHA launched work-related stress are mentioned in the OSH strategy as priorities. the European Survey of Enterprises on New and Emerging Risks Sometimes national strategies also provide for specific measures (ESENER), which is the first Europe-wide survey on health and to address them such as the adoption or revision of legislation; safety at the workplace. ESENER paid particular attention to the design of protocols, guidelines and other tools; cooperation with area of psychosocial risks, including stress. In this context two social partners and other institutions. report were published: Drivers and barriers for psychosocial risk For example, in Argentina the II National Strategy for Health and management: an analysis of the findings of the European Survey Safety at Work 2015-2019 adopted by the Superintendence of of Enterprises on New and Emerging Risks (ESENER) (2012); Occupational Risks (SRT) from the Ministry of Labour includes and Management of psychosocial risks at work: an analysis of several provisions related to psychosocial hazards and risks, such the findings of the European Survey of Enterprises on New and as development of protocols and guides for their assessment; Emerging Risks (ESENER) (2012). design and validation of diagnostic instruments for their early EU-OSHA also produced several reports on psychosocial risks detection and prevention;XXVIII development of specific regulations and work-related stress, such as Calculating the cost of work- in consultation with social partners; establishment of procedures related stress and psychosocial risks (2014), New risks and trends in the safety and health of women at work (2013); Wellbeing at work: creating a positive work environment (2013); Mental XXVI The Nordic Council is the official inter-parliamentary body in the Nordic Region. health promotion in the workplace – A good practice report It was created in 1952 to promote cooperation between the parliaments and (2011); Workplace Violence and Harassment: a European Picture governments of Denmark, Iceland, Norway and Sweden; Finland joined in 1955. The Nordic Council established in 1971 the Nordic Council of Ministers, which is (2011); Expert forecast on emerging psychosocial risks related the official body for Nordic intergovernmental co-operation. to occupational safety and health (OSH) (2007); How to tackle XXVII This part is intended to provide some examples of governmental initiatives psychosocial issues and reduce work-related stress (2002); and and good practices to deal with work-related stress, rather than to provide an Prevention of psychosocial risks and stress at work in practice exhaustive compilation from all countries. XXVIII The study on the validation of the instrument was published in 2015.

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS 19 and definition of responsibilities regarding the identification, Some countries shaped specific national strategies on mental evaluation, prevention, intervention and on-going monitoring of health, which include promotion of mental health at work and exposures; study and determination of the origin of diseases the prevention of psychosocial risks. For example, the Mental caused by work-related stress.213 Health Commission of Canada (MHCC) designed the first national mental health strategy, working to reduce stigma, advancing In Australia, the Work Health and Safety Strategy (2012–2022) knowledge exchange on mental health, and examining how best promotes a vision of healthy, safe and productive working lives, to help people who are homeless and living with mental health highlighting those categories of work-related disorders to be problems.XXX The strategy consists of six strategic directions, considered as a national priority (one of them being mental including the promotion of lifelong mental health in homes, disorders) and sets the objectives to be achieved by 2022.214 schools, and workplaces.223 In Spain, the Spanish Strategy on In Denmark, psychosocial risks have been included as one of Mental Health of the National Health System adopted in 2006 and the priority areas in the national strategy for OSH for the period updated in 2009, also includes objectives relating to occupational 2012–2020. The strategy adopted quantitative targets and aims health, recommending in particular that regions should support the at a twenty per cent reduction in the number of psychologically prevention of work-related stress, burn-out and mental disorders overloaded workers by 2020.215 associated with work. The update of the strategy in 2009 added a recommendation that regions should tackle mental health and In Finland, the Policies for the Work Environment and Wellbeing promote better working conditions for vulnerable groups, especially at Work 2011- 2020 adopted by the Ministry of Social Affairs and women.224 Health pay special attention to the work environment and wellbeing at work, including psychosocial risks.216 Based on this framework, Some national institutions also conduct awareness-raising several initiatives have been implemented, including the Working campaigns on work-related stress and mental health at work. Life 2020 project, the Forum for Wellbeing at Work, the Leadership For example, in Australia the National Mental Health Commission development network, and Liideri – Business, Productivity and Joy established the Mentally Healthy Workplace Alliance in 2013; the at Work Programme 2012–2018.217 Alliance promotes a national approach by business, community and government to encourage Australian workplaces to become In France, the government adopted the Emergency plan for the mentally healthy. In partnership with Beyond Blue (a non- prevention of stress at work in October 2009, in the context of a profit organization working to address issues associated with XXIX wave of suicides. The plan included four main objectives: (i) an depression, anxiety and mental disorders), the Alliance conducted obligation on enterprises employing more than 1,000 workers to the Heads Up national campaign, producing resources and start negotiations towards the elaboration of an Agreement or an interactive tools to enable large and small enterprises, managers Action Plan on stress at work; (ii) organization of regional seminars and workers to identify psychosocial risks and take appropriate on psychosocial risks; (iii) work on integrating psychosocial measures to create mentally healthy workplaces.225 In South Africa risks into restructuring plans; (iv) creation of a Department on the National Institute for Occupational Health (NIOH) has become psychosocial risks in the General Labour Department of the an important resource for developing and supporting effective 218 Ministry of Labour. In particular, this Department has developed occupational health services in South Africa. NIOH, in collaboration a model for understanding and prevention of psychosocial risks, with the Department of Health, conducted an awareness-raising which has been used by the government to develop tools and campaign during October 2015, which has been declared Mental guidance to help enterprises, in particular SMEs, to comply with Health Awareness Month with the objective of educating the public their obligations and manage internal crises. Psychosocial risks on mental health and on reducing stigma and discrimination.226 have been integrated in the 2010-2014 national occupational health plan in which they have been prioritized as a top risk in the field of OSH. RESEARCH AND THE EVIDENCE-BASE In Germany, the Joint German Occupational Safety and Health In many countries, national OSH institutes are in charge of Strategy sets out three goals to be achieved between 2013 and conducting research and surveys in the field of psychosocial 2018: (i) to improve the organization of occupational health; (ii) risks and work-related stress. For example, the Finnish Institute to reduce work-related illnesses arising from musculoskeletal of Occupational Health (FIOH) has a team producing information disorders; and (iii) to better protect workers from psychological on psychosocial factors and changes that have significant health strain at work.The Federal Ministry of Labour and Social Affairs effects, determining the mechanisms that influence health, studying and its social partners also issued a joint Declaration on Mental 219 the significance of social capital for wellbeing, and assessing the Health in the Workplace in 2013. In relation to the third goal effectiveness of the methods used by organizations to prevent on psychological strain at work, a new programme named health problems and promote health.227 Psyche was launched in 2015.220 In France, the Directorate for Research, Studies and Statistics In Mauritius, the Ministry of Labour, Industrial Relations and (DARES) conducts the national survey on Medical Monitoring Employment, in consultation with social partners, formulated of Risks (SUMER) which includes psychosocial exposure in March 2015 a national OSH policy which refers to specific measurements. Based on the 2010 survey DARES designed measures to be taken concerning physical, chemical, biological, 221 a series of indicators on work demands, emotional demands, ergonomic and psychosocial hazards in the workplace. autonomy, social and labour relations, value conflicts, and socio- In New Zealand, the Workplace Health and Safety Strategy to 2015 economic insecurity.228 The National Institute of Research and envisioned a healthy workforce in safe and productive workplaces, Safety (INRS) aims at improving knowledge of psychosocial risks where the term “healthy” encompasses physical, mental and social and their health effects, and understanding phenomena related wellbeing. The strategy defined psychosocial work factors as one to work activities or changes in the world of work that may lead of the national priorities, including excessive workloads, low job to the degradation of physical or mental health or, conversely, its control, aggression and violence at work, which can all contribute preservation. The INRS also analyses existing prevention practices to chronic fatigue, stress-related disorders, alcohol and drug with a view to developing and disseminating new approaches abuse, heart disease, upper limb musculoskeletal disorders, and adapted to a range of work situations. Within this framework INRS suicide.222 produced a number of publications, guides and tools.XXXI

XXX The Federal Government created the Mental Health Commission of Canada XXIX Suicides in the France Télécom Orange telecommunications group during (MHCC) in 2007 with a 10-year mandate (2007-2017). 2009 gave rise to jurisprudence once they had been recognized as having an XXXI The INRS resources on psychosocial risks are available in French at http://www. occupational origin. inrs.fr/risques/psychosociaux/ce-qu-il-faut-retenir.html

20 WORKPLACE STRESS: A COLLECTIVE CHALLENGE In Germany, the Federal Institute for Occupational Safety and GUIDELINES Health (BauA) conducts research in the field of safety and health at work and promotes the transfer of knowledge into practice, The first guidelines on the psychological and social aspects including on work-related stress and psychosocial risks. For of the working environment (Psykiska och sociala aspekter på example, in 2012 BauA published the German report on stress arbetsmiljön) were introduced in 1982 by the Swedish Working (Stressreport Deutschland 2012) based on interviews with over Environment Authority (AV). These guidelines highlighted the 20,000 workers to estimate stress and strain exposure.229 importance of personal and professional development, the need for social contact, the organization of work, workers’ awareness In Japan, one of the research groups from the Japanese of their coresponsibility for safety and health at the workplace, National Institute of Occupational Safety and Health (JNIOSH) physical and chemical factors, and the planning of working is working in the field of health administration and psychosocial hours.233 factors, investigating methods of assessment of workers’ health conditions and health management. In recent years, the group Since then several countries have developed guidelines on developed a number of projects, such as Health, performance, and prevention of work-related stress, protection of mental health wellbeing under flexible working time arrangements, Healthy work and assessment of psychosocial risks. For example, in Japan organizations for mental health in the workplace, and Associations the government issued guidelines to help employers protect the between psychosocial stress and depressive symptoms among mental health of workers. The guidelines were first released in workers and preventive measures in the workplace. A research 2000, then revised and in 2006 renamed the New Mental Health project on Facilitating recovery from fatigue at work is currently Guidelines. They require the employer to establish a system and on-going.XXXII a plan of action to protect the mental health of workers, based on discussion between the employer, workers’ representatives, In 2000 the National Institute for Occupational Safety and Health OSH professionals and the OSH workplace committee. These (NIOSH) of the US started collaborating with the National Science new guidelines focus on four activities which could be effective: Foundation to add to the General Social Survey a special module (i) education, training and information dissemination; (ii) work XXXIII assessing the quality of work life. Since 2002 this biannual environment improvement; (iii) early consultation with workers; and survey includes the Quality of Worklife module (76 questions (iv) support for return to work of the mentally ill.234 addressing a variety of work organization issues). In 2010 the module was modified to reflect emerging risk factors in relation to The tripartite Economic and Social Council (CES) of Luxembourg workers’ safety and health.230 The National Occupational Research has developed guidelines on work-related stress. The CES Agenda (NORA) of NIOSH identified organization of work as one guidelines describe the negative individual and organizational of the 21 priority areas for occupational health research since its impact of work-related stress. They provide a step-by-step conception in 1996. The organization of work team collaborated approach to procedures for identification and management of with academia, industry and other stakeholders to study how work psychosocial hazards and define the duties and rights of workplace organization is changing, the safety and health implications of actors.235 these changes, and necessary prevention measures. In 2004 they In Malaysia, the Department of Occupational Safety and Health published the report The Changing Organization of Work and the (DOSH) published the Guidance for the prevention of stress and Safety and Health of Working People. violence at the workplace (2001) to offer an integrated response In Singapore, the Workplace Safety and Health (WSH) Institute to these problems which often arise together in the workplace. It is dedicated to providing education, knowledge, solutions and introduced an innovative approach whereby workers’ health, safety consultancy services, as well as conducting applied research. and wellbeing become integral parts of the economic sustainability Work-related stress is one of the Institute’s focus areas of research. and organizational development of enterprises. By directly linking In particular the WSH Institute is leading a two-year study in health and safety with managerial and developmental issues the partnership with the Health Promotion Board, Changi General guidelines offer tools for immediate, self-sustained action at the Hospital and the Institute of Mental Health on Evaluating Resilience workplace to reduce and eliminate stress and violence.236 and Stress in Employment (ERASE, 2015-2017). The study has In Mexico, the Directorate on OSH from the Ministry of Labour the purpose of developing and validating a local instrument for the in consultation with the National Tripartite Committee on OSH assessment of workers’ psychosocial health, and the identification (COCONASH) is developing technical guidelines on psychosocial and management of psychosocial hazards and risks. The study risks to complement the new OSH Act. aims at understanding how psychosocial hazards and individual resilience influences workers’ stress levels and mental wellbeing. In Singapore, following the adoption of the Protection from The study will result in a validated online tool for employers and Harassment Act (POHA) in 2014,XXXV in order to help employers workers to assess and manage psychosocial risks and stress and workers adopt preventive measures and undertake proactive levels. It will also provide evidence-based recommendations for management and remedial actions (if harassment occurs) industry on the management of psychosocial hazards and risks.231 to ensure a safe and constructive workplace, the Ministry of Manpower (MOM), the National Trades Union Congress (NTUC), The Swedish Council for Working Life and Social Research (FAS) and Singapore’s National Employers Federation (SNEF) jointly supports the Stockholm Stress Center, which was created in 2009 issued Tripartite Advisory guidelines on Managing Workplace 232 as an interdisciplinary centre for research on work-related stress. Harassment.237 In the UK, the Health and Safety Executive (HSE) produces In Spain, the National Institute of Safety and Hygiene at Work statistical information on work-related stress, based on data (INSHT) adopted several preventive technical factsheets (NTP) from the annual Labour Force Survey and from the Psychosocial on psychosocial risks and work-related stress, which help in Working Conditions survey. HSE also has produced several identifying the risks and establishing preventive measures to papers and studies, in particular on stress management and address them. interventions.XXXIV

XXXII A list of the studies of the Health Administration and Psychosocial Factor Research Group is available in English in the JNIOSH website (https://www.jniosh. go.jp/en/groups/themes_health.html). XXXIII The General Social Survey is a biannual, national, personal interview survey of US households conducted by the National Opinion Research Center and funded by XXXV The POHA was introduced by the Ministry of Law to provide civil and criminal the National Science Foundation. recourse to better protect individuals from harassment and related anti-social XXXIV A list of key research publications on work-related stress is available on HSE’s behaviour. For more information see: https://www.mlaw.gov.sg/content/minlaw/ website (http://www.hse.gov.uk/stress/research.htm). en/news/press-releases/protection-from-harassment-act-in-force.html

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS 21 INTERVENTION TOOLS and its outcomes, particularly on stress, violence, bullying, and other behaviour in the work environment.241 In Costa Rica, the National institutions from a number of countries have developed Occupational Health Council (CSO) of the Ministry of Labour and monitoring models, risk assessment and management tools, and Social Security aims at promoting decent, safe and competitive other awareness-raising initiatives to help understand and prevent workplaces. CSO provides information and resources on work-related stress.XXXVI psychosocial factors and their impact.242 In France, the National Among the monitoring models, the Copenhagen Psychosocial Agency for the Improvement of Working Conditions (ANACT) Questionnaire (COPSOQ) developed in 1997 by the National helps enterprises adopt policies for the prevention of psychosocial Research Centre for the Working Environment of Denmark, was risks through direct interventions in enterprises and publication 243 the first to include population-based reference values to assess of guides. In addition, ANACT manages the Fund for the the need for action and to support the decision-making process Improvement of Working Conditions, which finances enterprise on preventive measures at workplace level.XXXVII It included three projects aimed at improving working conditions, one of the four versions of different length: a long version for research; and focus areas being stress and psychosocial risks. In Ghana, medium-length and short versions for workplace risk assessment, the Employee Wellbeing Programme is a collaborative initiative depending on workforce size. Since its initial development in between Ghana’s Ministry of Health and the German Society for Denmark, COPSOQ has been adapted and applied by researchers International Cooperation (GIZ). This voluntary initiative started in several countries. It is relevant to mention its adaptation by with a focus on tackling HIV/AIDS and further developed into a the Trade Union Research Institute of Work, Environment and general wellbeing programme, providing tools and policies for Health (ISTAS) in Spain with the name of COPSOQ/ISTAS21. This enterprises; it is heavily based on the WHO model for Healthy adaptation has been extensively used in Latin American countries Workplaces. The psychosocial work environment is part of the XLI and validated in Chile with the Questionnaire SUSESO/ISTAS 21, health and safety aspects of the model. In Peru, the Center for complementing the Protocol for Monitoring Psychosocial Risks at Scientific Information and Documentation (CINDOC) of the National Work adopted in 2013 by the Department of Occupational Health Center of Occupational Health and Environmental Protection for of the Ministry of Health.238 The protocol also provides the Tool for Health (CENSOPAS) provides information on psychosocial risks the Assessment of Preventive Measures for Psychosocial Risks and on mobbing and bullying in the workplace, along with training 244 at Work. The COPSOQ/ISTAS21 was also validated in Argentina for medical practitioners and engineers. The Swedish Work in 2015.239 The Spanish National Institute of Occupational Safety Environment Authority (AV) produced several guides and reports and Hygiene (INSHT) developed its own method for evaluation on work-related stress for employers and union representatives, of psychosocial risks in the workplace (F-Psico) to facilitate such as the Systematic work environment management against identification and evaluation of psychosocial risks.XXXVIII stress (2002) and Illness and negative stress – in a changing work environment (2002).245 In the UK, the National Institute for Health Examples of risk assessment and management tools developed and Clinical Excellence (NICE) produces guidelines for employers, by national institutions in collaboration with universities include such as Mental wellbeing at work (2009) and Workplace health: the Australian People at Work Project launched in 2007 to help management practices (2015).246 enterprises identify and manage psychosocial risks.XXXIX The enterprises that participated in the project have access to an online risk assessment tool and resources for implementing SOCIAL SECURITY INSTITUTIONS psychosocial risk management and evaluating the effectiveness of chosen interventions. Data collection methods include worker Relevant initiatives have also been developed by national insurance surveys and focus groups with an optional follow-up measure.240 institutions. For example, in Italy the Research Area of the National Another example is provided by the HSE in the UK that developed Insurance Institution for Occupational Injuries (INAIL) developed a process based on a set of Management Standards to help in 2011 a methodological proposal for the management of employers, workers and their representatives manage and reduce psychosocial risks. It consists of a dynamic path with four key work-related stress levels. The Management Standards for Work- phases (planning, preliminary assessment, in-depth assessment, related Stress refer to good management practices regarding and risk management) based on a continuous improvement cycle, 247 six main psychosocial risks in the workplace (i.e. job demands, as with other OSH management systems. The German Social control, support from management and peers, relationships at Accident Insurance (DGUV) developed a number of materials on work, clarity of role, and organizational change).XL work-related stress including checklists, guidelines, manuals and reports. An interesting DGUV initiative is the design of a module In several countries national institutions have also developed on stress for use by teachers in vocational training schools.248 In information resources to help employers and workers understand, Slovakia, the Public Health Authority (ÚVZ SR) and its regional assess, manage and prevent psychosocial risks. For example, the offices have since 2008 been carrying out a range of activities Canadian Centre for Occupational Health and Safety (CCOHS), aimed at preventing and reducing stress at work. These include governed by a tripartite Council, promotes total wellbeing registering those professions and jobs noted for a relatively (including physical, psychosocial and mental health) among high risk of stress, monitoring development trends in the mental Canadian workers by providing information, training, education and health of the workforce in Slovakia and providing guidance for solutions that support health, safety and wellness programmes. employers and workers in this field.249 The Swiss National Accident CCOHS developed several resources on psychosocial hazards Insurance Fund (Suva) is Switzerland’s largest provider of accident insurance, managed by a board of employers, workers and federal representatives. Through the Progress (Progrès) project Suva aims XXXVI Relevant tools, including those mentioned in this section, are listed in Annex 1 with at defining research priorities and developing prevention tools to references and links (when available). address work-related diseases. The psychosocial effects (including XXXVII COPSOQ is now available in more than 25 languages. More information at: http:// stress, burnout, mobbing and work-life balance) and their impact www.copsoq-network.org/index.php on the human factor that can cause accidents are priority areas of XXXVIII The current version Factores Psicosociales. Método de evaluación. Versión 3.1 (F-PSICO 3.1), updated in 2014, is available online on the INSHT website (www. the project. Additionally, the Progress working group is dedicated insht.es). to the study of work and the cardiovascular system, work and 250 XXXIX People at Work is a collaborative initiative between the Australian Federal physical activity, and work and aging. Government, the Government of Queensland, Government of New South Wales, Safe Work Australia, WorkSafe Victoria, the University of Queensland and the Australian National University. XL The Platform contains detailed guidance, an Indicator Tool, case studies from a range of enterprises, focus groups guides, and examples of interventions across sectors (http://www.hse.gov.uk/stress/standards/). The Management Standards developed by the HSE were incorporated in Ireland in the updated Work Positive XLI However the process of psychosocial risk assessment and management is at a tool (targeted at small enterprises) and in Italy. very early stage in Ghana, and until now activities have been limited (GIZ, 2012).

22 WORKPLACE STRESS: A COLLECTIVE CHALLENGE of Swedish Enterprise, the Swedish Trade Union Confederation, SOCIAL PARTNERS’ and the Council for Negotiation and Cooperation (PTK), founded Prevent to provide guidance and training on work-related stress.XLIII ENGAGEMENT In 2011 Prevent launched a new initiative on IT-related stress, which tackles stress arising from problems with technology, constant Attention to psychosocial risks and work-related stress is growing online presence and information, social media updates, the constant among social partners at global, regional and national levels. receiving of emails which require replies, and so forth.253 Employers’ organizations and trade unions have developed a number of independent initiatives including information Employers’ and workers’ organizations also conducted national dissemination and awareness-raising campaigns. Most joint or sectoral awareness-raising campaigns. For example, in Latvia activities developed in Europe are part of the implementation of social partners organized an awareness-raising campaign on stress the EU Framework Agreement on Work-related Stress mentioned together with the State Labour Inspectorate (Stop overwork!), above.XLII and another in cooperation with the Ministry of Health (Love your Heart!).254 Other relevant initiatives jointly implemented by social partners EMPLOYERS AND WORKERS JOINT include assessment tools, such as the IMPULS test developed in ACTIVITIES Austria by occupational and health psychologists in cooperation with the Austrian Federal Economic Chamber (WKÖ), the Austrian Several European social partners from different sectors (e.g. public Chamber of Labour (BAK) and the Austrian Trade Union Federation administration, education, private security, construction, electricity (ÖGB). IMPULS test is a questionnaire assessing working sector) have included work-related stress in their social dialogue. conditions and detecting stress factors. It identifies areas of For example, in the public administration the European Public intervention for optimising resources and implementing measures Administration Network (EUPAN) and the Trade Unions’ National to reduce work-related stress.255 and European Administration Delegation (TUNED) adopted in 2008 joint guidelines on work-related stress. In 2009 EUPAN and TUNED issued a report on good practice and policies on work- related stress to provide concrete illustrations of their joint position EMPLOYERS’ ORGANIZATIONS INITIATIVES and help refine lessons learned on how to combat and prevent it. Employers’ international organizations and networks are also The European Sectoral Social Dialogue Committee for Education demonstrating increased interest in addressing psychosocial included the issue of “stress, violence and harassment” in its 2010- risks and mental health at work. For example, the International 2011 work programme. The European Trade Union Committee for Organization of Employers (IOE) supports national business Education (ETUCE) conducted an initial project on teachers’ work- organizations in guiding corporate members on matters of related stress in 2007 and in 2008 adopted the ETUCE’s Action International Labour Standards, business and human rights, Plan on Teachers’ Work-Related Stress. corporate social responsibility (CSR), OSH, and international In 2004 the European Trade Union Confederation (ETUC), the industrial relations. The IOE has a number of guides and awareness Union of Industrial and Employers’ Confederations of Europe factsheets to help employers promote good practice concerning (UNICE, now known as BUISNESSEUROPE), the European workers’ safety, health and wellbeing, work-related health risks 256 Association of Craft Small and Medium-sized Enterprises including mental disorders. (UAEPME) the European Centre of Enterprises with Public At regional level, BUSINESS EUROPE is committed to ensuring Participation and of Enterprises of General Economic Interest a safe, healthy and productive workforce, including protecting (CEEP) signed the EU Framework Agreement on Work- workers from psychosocial risks and work-related stress. related Stress. In 2008 the European social partners (ETUC, BUSINESS EUROPE is engaged in developing expertise and tools BUSINESSEUROPE, UAEPME and CEEP) issued a report on which can be adapted to different realities to help enterprises implementation of the Agreement, based on joint national reports address psychosocial risks.257 Employers’ networks are also active from member organizations in 21 EU member States, Iceland and in this field. CSR Europe (the European Business Network for Norway.251 Corporate Social Responsibility) developed in 2009 the Wellbeing As part of the implementation of the Agreement, social partners guidebook, which contains eleven straightforward practical tips jointly developed and disseminated brochures, guides and for implementation, a detailed analysis of the elements affecting educational materials on psychosocial risks and work-related mental health and wellbeing, and a collection of best-practice stress in a number of EU countries (e.g. Austria, Belgium, Czech examples in support of the suggestions and recommendations in 258 Republic, Denmark, Estonia, France, Ireland, Latvia, Lithuania, the guidebook. The network also provides examples of good Luxembourg, Germany, Poland, Spain, Sweden, and United practice adopted by enterprises in the field of OSH and wellbeing, Kingdom). For example, in Belgium social partners developed a including initiatives on mental health and stress at work. brochure providing a comprehensive plan for designing a policy on At national level, employers’ organizations are starting to pay stress at work. The brochure describes a step-by-step approach increasing attention to psychosocial risks, developing awareness- to evaluation and intervention in respect of psychosocial risks in raising and training activities along with tools and materials to the workplace. It also draws attention to specific risks that arise in facilitate better understanding and prevention of work-related times of restructuring and introduction of new technologies.252 stress. For example, the Bulgarian Industrial Association (BIA) In some countries social partners jointly organize training, has developed questionnaires for the appraisal of work-related workshops and conferences on these issues. For example, the stress at enterprise level, which are used in its OSH training Polish trade union NSZZ Solidarno, in partnership with other programme for employers and their representatives in safety and cross-industry social partners, carried out a transnational project health committees and safety groups. On the basis of the findings, on work-related stress. This included training, a brochure, and measures and services are offered to individual employers to help 259 negotiation workshops in Poland, as well as an international them develop programmes to limit stress. The Irish Business conference during which social partners from Italy, Lithuania, Malta and Employers’ Confederation (IBEC) developed a guide providing and Slovenia exchanged views on the challenges encountered information and orientation for line managers in promoting in implementing the Agreement. In Sweden, the Confederation mental wellbeing and in understanding and supporting workers

XLII This section is intended to provide some examples of social partners’ initiatives to XLIII Prevent is a non-profit organization owned by the Confederation of Swedish deal with psychosocial risks and work-related stress, not to provide an exhaustive Enterprise, Swedish Trade Union Confederation, and the Council for Negotiation compilation from all countries. and Cooperation (Förhandlings- och samverkansrådet, PTK).

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS 23 experiencing mental health problems, highlighting strategies for The General Council on Gender Equality observed that violent managing mental health related issues in the workplace.260 situations at work result in emotional and psychological burdens for both women and men who have to cope with them.268 The European Trade Union Confederation (ETUC) produced TRADE UNION INITIATIVES two guides for interpretation of the framework agreements on The International Trade Union Confederation (ITUC) in its work-related stress (2004) and on harassment and violence at Congress Resolutions on Decent Work of 2010, called its work (2007). They expect to support member organizations in the member organizations, partners and affiliates to work with the ILO implementation of these agreements and allow better monitoring to campaign for the extension of social protection to all, and for and evaluation of the results achieved after their adoption.269 improving OSH in all countries, including prevention of exposure The ETUC action programme 2015-2019 Stand up in solidarity to hazardous chemicals, psychosocial hazards and occupational for quality jobs, workers’ rights and a fair society in Europe calls injuries and accidents.261 for action in the field of work-related stress, emphasising that an increasing number of workers do not have enough working th During its 16 World Trade Union Congress in 2011, the World hours, while others suffer from stress due to work intensity or Federation of Trade Unions (WFTU) issued a report on the health long working hours. In addition, considering that studies have and safety of workers in our time. The report calls for action in shown that risk assessment still focuses mainly on physical the field of OSH, taking into account the fact that “health doesn’t hazards but takes little account of psychosocial hazards (such only mean absence of illness, but a situation of physical, mental as those causing work-related stress, violence, harassment or and social wellbeing”. The report states that the extension of the mobbing), ETUC proposed the development of indicators to working day and the increase in the pace and intensity of work measure such risks, as well as well-designed and systematic have serious consequences for the physical and mental health work environment plans and measures.270 The European Trade and social involvement of workers; that the increase in workers’ Union Institute (ETUI), the independent research and training exposure to harmful physical, chemical, psychosocial and centre of ETUC, organized the first European trade union seminar biological factors will lead to multiple changes in their health; that on psychosocial risks in June 2013. A European trade union each type of flexible working arrangement limits the capability network focusing on psychosocial risks at the workplace was of workers to reclaim their free time; and that in this context officially set up during this meeting.271 regularity of working hours is essential for the normal social life of workers and is thus directly related to their state of health.262 At national level, trade union action often includes struggles against violence and harassment, discrimination, long working

Building and Wood Worker’s International (BWI) and IndustriALL hours and precarious work. Even if considered outside the Global Union are addressing specific psychosocial risks within framework of work-related stress, these areas embody the framework of promoting gender equality, advocating inter alia psychosocial hazards which can damage workers’ health and reduced segregation and discrimination, closing of the pay gap, wellbeing. In the last decade some national trade unions started tackling of violence (both physical and psychological) against to consider psychosocial risks and work-related stress as

women and an improved work-life balance. UNI Global Union is critical areas of work, developing awareness-raising materials also active in the field of psychosocial risks. Its 2010 report, From and campaigns along with questionnaires and assessment Work-Life Balance to Work-Life Management identified the key tools. For example, in Germany the Confederation of German work-life management issues faced by many professionals and Trade Unions (DGB) has developed the Good Work Index, a managers, such as long hours, loss of talent, and flexibility. Many tool for conducting surveys among workers. Data are compiled of these challenges apply in different ways across UNI’s sectors, in an annual survey to assess and monitor the quality of (such as ICTS, finance, post and logistics, graphical, commerce working conditions.272 In addition, the trade union IG Metall 263 and property services). Since 2012 the Professionals and has developed for its members a stress evaluation tool named Managers group (UNI P&M) of UNI Global Union has organized Stress Barometer; while the trade union ver.di has published an the Work-Life Management Fortnight, a one-week campaign, online guidance document on psychosocial risk assessment.273 aimed at discussing the impact of psychosocial risks, stress, In Spain, the Trade Union Institute of Work Environment and anxiety or burnout on members and seeking to negotiate Health (ISTAS), together with a task force of specialists, adapted better policies and practices to improve work organization, in 2003 the COPSOQ Copenhagen questionnaire to create reduce workload and pressure, and address the demand the COPSOQ-ISTAS21 methodology, based on pilot projects 264 for constant availability. Within the International Transport aimed at producing an assessment tool adapted to the Spanish Workers’ Federation (ITF), the ITF Seafarers Section highlights context.XLIV The Spanish General Workers Union (UGT) created in psychological problems as health issues for seafarers, given that 2004 the Permanent Observatory of Psychosocial Risks, aiming their isolated circumstances can cause loneliness, homesickness at sharing of information and development of new initiatives to 265 and burnout. prevent psychosocial risks in collaboration with institutions, public The Labour 20 (L20) has represented the interests of workers administration and universities.XLV at G20 level since 2011. It involves trade unions from G20 countries and Global Unions, and is convened by ITUC and the Trade Union Advisory Committee to the OECD (TUAC). In 2014 L20 was invited to discuss the way in which G20 countries could contribute to healthy and safe workplaces. L20 called for the development of country roadmaps for promoting safer workplaces, to address inter alia psychosocial risks, stress, harassment, bullying or mobbing and other forms of violence at work, along with improved attention to OSH protection for workers in non-standard forms of employment and for vulnerable workers.266 At regional level, the African Regional Organization of ITUC (ITUC- XLIV Africa) in its Report to the African Union Labour and Social Affairs The questionnaire is accessible online free of charge at the following link: http:// www.copsoq.istas21.net/. It is available in a long version for enterprises employing Commission (2013) highlighted that globalization had given rise to more than twenty-five people, and in a short version for auto-evaluation and new OSH challenges in the region, such as work-related stress, smaller enterprises. violence at work, drug abuse and alcoholism.267 In addition, ITUC- XLV The Permanent Observatory of Psychosocial Risks has produced several Africa continues to pursue affirmative action to push forward the resources on psychosocial risks, including fact sheets (available at: http://portal. ugt.org/saludlaboral/observatorio/fichas/fichas.htm) as well as their annual report gender equality agenda in the context of trade union statutes. (available at: http://portal.ugt.org/saludlaboral/observatorio/indice_observatorio.htm).

24 WORKPLACE STRESS: A COLLECTIVE CHALLENGE Network for Dignity at Work and in the Organizations was PROFESSIONAL created in 2011 during the first Ibero-american Congress on Workplace and Institutional Harassment. The second Congress ASSOCIATIONS’ AND was held in 2013 and represented the starting point for the publication Labour and Institutional Psychological Harassment in NETWORKS’ CONTRIBUTION Latin America: State of the art and intervention experiences.276 The Latin American Research Network on Psychosocial Factors A number of professional bodies and associations and at Work (RIFAPT) is a non-profit organization of professionals non-governmental organizations are active in promoting focusing on promotion, dissemination and advancement of management of work-related stress and wellbeing at work, at research and knowledge on psychosocial factors at work. It international, regional and national levels. A number of regional organizes a regional forum every two years. and national professional networks are also active in the field of tackling psychosocial risks and promoting mental health and In the Asian-Pacific region, the AESAN Occupational Safety wellbeing at work by coordinating research with a view to a and Health Network (AESAN-OSHNET) aims at fostering a better understanding of the nature and impact of psychosocial safe and healthy working environment for a productive and risks and for designing effective interventions to tackle them at competitive workforce with a better quality of life. To promote organizational level.XLVI systemic stress reduction AESAN-OSHNET developed the Stress Management Program in Workplace, consisting of two The International Commission on Occupational Health (ICOH) parts, the first focusing on how to cope with stress-generating is an international non-governmental scientific society with the problems and handle emotional consequences, the second objective of fostering development of scientific knowledge on addressing self-management in preventing stress in particular OSH. In 1996 ICOH created its scientific committee on Work areas, namely healthcare and emotional and psychological Organization and Psychosocial Factors (WOPS). This committee care.277 The Asian Pacific Academy for Psychosocial Factors at aims at promoting awareness, research and education, Work (APA-PFAW) is a non-profit, non-governmental, scientific dissemination of good practices and at influencing policy and professional organization. The goal of the Academy is development in the area of work organization and psychosocial to bring together academics, practitioners and policymakers factors. In 2014 ICOH published the sixth version of the Guide from the region and beyond to discuss psychosocial factors at to Occupational Health and Safety for Entrepreneurs, Owners work, to share and generate knowledge, deliver education and and Managers, Creating a Safe and Healthy Workplace, which training, build greater networks and opportunities to prevent contains a chapter on stress, including a checklist of simple work injury, contribute to better working arrangements, and to measures for managing it.274 improve workplace health, safety, wellbeing and productivity in 278 The International Organization for Standardization (ISO) is the the region. world’s largest developer of voluntary international standards. In the EU, the European Academy of Occupational Health The ISO 10075 series of standards covers principles, Psychology (EA-OHP) is an organization established in 1999 requirements and instruments for the measurement of mental to support research, education, and professional practice on workload. The standards are mainly intended for use by occupational health psychology across Europe. The Academy ergonomic experts (e.g. psychologists, occupational health organizes a major international conference on occupational specialists, and physiologists), with appropriate training in the health psychology every two years to promote discussion and theoretical background and practice of such methods, as well sharing of best practice in this field. EA-OHP is also associated as in the interpretation of results. 275 with the journal Work & Stress, an international, multidisciplinary Other relevant international professional associations which quarterly presenting peer-reviewed papers concerned with cover protection of mental health and prevention of work-related the psychological, social and organizational aspects of stress as part of their scope include the International Ergonomic occupational and environmental health, and of stress and safety 279 Association (IEA), which covers different areas of specialization management. The European Network Education and Training within the ergonomics discipline, namely physical, cognitive and in Occupational Safety and Health (ENETOSH) was set up in organizational ergonomics; the International Institute of Risk 2005 to offer a platform for systematic knowledge-sharing on and Safety Management (IIRSM), a professional body which issues concerning education and training on OSH. One of the provides education, resources and networking opportunities for issues highlighted by ENETOSH (Hot Topics) is Stress and developing and implementing integrated risk policies (including Psychosocial Risks, presenting a collection of good practice 280 raising awareness of the effects of psychosocial risks and examples, tools, training materials, and useful documents. how these are being affected by changes in organizational The European Network for Mental Health Promotion (ENMHP) culture and new working methods); and the International Stress provides information, tools and methods, training and a Management Association (ISMA) which promotes dissemination communications platform for all who are interested in this and exchange of knowledge and best practice through events area. The ENMHP has an online portal which comprises and conferences, publication of STRESSTalk and other journals, three other websites aimed at promoting mental health and guides and information, and professional networking. wellbeing: ProMenPol, a database of tools and methods; MindHealth, with an e-learning course; and MHP-Hands, which In the Americas, the Ibero-American Network for Work-related contains the support manuals for implementing mental health Psychosocial Risks (RIPSOL) promotes communication promotion projects.281 The European Network for Workplace and scientific collaboration on potentially harmful working Health Promotion (ENWHP) is an informal network of institutes conditions which are contributory causes of cardiovascular concerned with national OSH, public health, health promotion, disorders, musculoskeletal injuries, mental health and and statutory social insurance. It was formally established in behavioural disorders such as stress, burnout, harassment 1996 to improve workplace health and wellbeing and to reduce and psychological violence and behavioural disturbances. the impact of work-related ill health on the European workforce. The network is developing and improving instruments and The areas of activity include life-styles, ageing, corporate culture procedures for the assessment and diagnosis of such risks and staff leadership, staff development, work-life balance, mental their effects on health, along with techniques and procedures health and stress, wellness, corporate social responsibility for psychosocial interventions on them. The Ibero-American (CSR), nutrition and general health. With the European campaign naimed Work in Tune with Life. Move Europe (2009- 1010), ENWHP launched an initiative to help promote mental health in workplaces with the aim of increasing the awareness XLVI This section provides some examples of international and regional professional association and networks active in this field, but not of those operating at national level.

4. STRATEGIES FOR THE PREVENTION AND MANAGEMENT OF PSYCHOSOCIAL HAZARDS AND RISKS 25 of enterprises and the general public of the needs and benefits of mental health promotion at work.282 The Partnership for European Research in Occupational Safety and Health 5. GLOBAL TRENDS (PEROSH) was established in 2003 by national OSH institutes in twelve European countries to cooperate and coordinate their research and development efforts for a healthier, longer and AND FORESIGHT more productive working life.XLVII PEROSH partners identified seven research challenges considered to be essential for future research in OSH up until 2020. Research in the field of OF FUTURE psychosocial wellbeing in a sustainable working organization is being undertaken to contribute to better understanding of the factors that determine physical, psychological and mental SCENARIOS health and their impacts, including the positive factors that may improve wellbeing, along with the development of integrated approaches to the management of psychological risks.283 Two studies were carried out by the ILO to assess trends PEROSH is also carrying out a project on wellbeing and work to and forecast future scenarios in relation to the impact of identify common needs for improving wellbeing and preventing psychosocial risks and work-related stress: an expert opinion ill-health, enabling those with ill-health to stay at work, and survey to detect drivers, barriers and needs in relation to the rehabilitating people who are away from work following ill- prevention and management of work-related stress; and a health or injury. The project aims at developing a common two-round Delphi survey to identify and assess future scenarios understanding of wellbeing and the drivers for research on and contributory factors (facilitators or inhibitors) in this area. wellbeing and interventions in the different countries, including Key experts were invited to take part in online surveys.XLVIII The the identification of similarities and differences between outcomes from the expert opinion survey and the literature, countries.284 legislative and policy reviews undertaken for this report were used to develop the first round of the Delphi survey, the results of which were used as inputs into the second round. It should be noted that comparing regions can be challenging, particularly since the expectations and concerns of experts could be influenced by developments in their country.XLIX While the lack of initiatives to address an issue can lead to increased concern and prioritization of this issue, greater awareness can also raise the level of concern, even if measures have been taken to address it. The findings from this survey, however, clearly highlight that there is a need to develop policy initiatives to improve the prevention and management of psychosocial hazards and risks and work-related stress, as well as to further prioritize these issues. A summary of the key findings is presented below.

EXPERT OPINION SURVEY A total of 324 experts from 54 countries across the world, covering all ILO regions, responded to the expert opinion survey.L The findings from the survey indicated that work-

XLVIII The group of experts included academicians or researchers (149), government officials or policymakers (54), OSH practitioners (113) and representatives of social partners, namely employers’ organizations and trade unions (8). Occupational health was the most prevalent discipline, followed by occupational psychology. Other areas of expertise included risk management, law and policy, and epidemiology. XLIX The findings from the survey are based on aggregated data at country level to account for any in-country variation and to provide an equal weight to each country irrespective of the number of responses from the country. This was done using a mean value for each item of the survey which was calculated by averaging the responses received from experts in each country. This ensured that when compared across regions, each country had the same weight and the variation in responses received from each country did not have an impact on the comparisons between regions. One of the limitations of the survey is the under-representation of social partners and is associated with the call for participation oriented more to experts than social partners. L The 324 experts were from Angola (4), Argentina (6), Australia (6), Austria (2), Belgium (4), Belize (4), Botswana (3), Brazil (9), Bulgaria (2), Burkina Faso (3), Canada (17), Chile (5), China (11), Colombia (2), Denmark (4), Egypt (3), Finland (3), France (10), Germany (4), Ghana (4), Greece (6), Hungary (6), India (15), Indonesia (3), Ireland (5), Italy (3), Ivory Coast (2), Japan (4), Libya (2), Malaysia (4), Mauritania (4), Mexico (12), Morocco (4), Netherlands (6), Norway (4), Poland (4), Portugal (21), Romania (4), Russia (4), Serbia (6), Singapore (13), South Africa (6), Spain (12), Sweden (2), Switzerland (2), Syrian Arab Republic (2), Tanzania (4), Thailand (2), Tunisia (2), Uganda (3), United Kingdom (22), United Arab Emirates (6), United States (19), Vietnam (4). XLVII The twelve European countries are: Belgium, Czech Republic, Denmark, Finland, Grouped by ILO regions, 44 experts were from Africa, 74 from the Americas, France, Germany, Italy, the Netherlands, Norway, Poland, Spain and United 8 from Arab States, 62 from Asia and the Pacific, and 136 from Europe and Kingdom. Central Asia.

26 WORKPLACE STRESS: A COLLECTIVE CHALLENGE related stress is a global problem, as over ninety per cent cultural aspects, such as sensitivity to psychosocial issues, risk of all participating experts agreed that it was a concern sensitivity and risk tolerance. The major contributing factors in their country.LI Furthermore, nearly seventy per cent of reported were lack of resources such as staff, time or money; them reported that work-related stress was a source of inadequate enforcement of regulations; lack of consensus higher concern in specific sectors, particularly in healthcare, between the social partners; and poor integration of these education, services, finance, the retail trade, transport and issues at national and workplace levels.LIII The findings are construction, and the public sector in general. generally consistent across regions and most of the barriers were rated as important or fairly important.LIV (See Annex 2, Figure 2.2). CONCERNS AND PRIORITIES In examining trends in relation to work-related stress, experts were asked to rate the extent to which various psychosocial DEVELOPMENT OF COMPETENCES TO factors overlapped as important concerns in their country; DEAL WITH WORK-RELATED STRESS and to indicate if any were recognized as a priority area for According to the experts’ opinion survey, the key following action by policymakers and if initiatives had been or were being elements should be taken into consideration in the development undertaken. of competences to address work-related stress: capabilities for The highest concerns reported were work overload (in the psychosocial risk management (at both national and workplace Americas, Asia-Pacific region, Europe and Central Asia) and levels); adequate knowledge of key stakeholders; relevant and poor organizational culture (in Africa and the Arab States). reliable information to support decision-making; availability of Work-life balance was identified as a concern across regions effective and user-friendly methods and tools; and competent and there was overall a substantial consensus that work support structures (specialists, consultants, services, institutions overload and time pressure are high concerns (except in the and research). Across a range of countries there are differences Arab States). Poor organizational culture, poor management, in existing knowledge and competences, especially in low reward and low recognition feature high in Africa and the developing countries. For example, only seventeen point five per Arab States. cent of experts from Africa reported being aware of guidelines on the management of work-related stress in their country as Physical violence, discrimination at work and harassment were compared to over thirty per cent of those from other regions. perceived by the experts as the most prioritized areas in their countries, eighty-seven per cent agreeing that psychological Concerning the necessary support and guidance for the violence is considered a priority by policymakers. Physical prevention and management of work-related stress, the findings violence (and threat of physical violence) and discrimination indicate that workplace guidance provided by independent at work were considered by most experts as concerns (over specialists and consultants, trade unions, national health ninety-eight per cent for physical violence and ninety-six services, national OSH bodies and occupational health services per cent for discrimination at work).LII Harassment (including was rated as more satisfactory than guidance provided by mobbing and bullying) was identified by all experts as an issue enforcement bodies, employers’ organizations and local health of concern in their country (with over fifty per cent reporting it services. Experts from Africa and the Arab States were less as a major concern). However, experts from Africa and the Arab satisfied with the provision of support and guidance available in States highlighted the lack of prioritization of physical violence, their countries. Furthermore, the overall provision of support and harassment and discrimination issues in their regions. guidance was largely rated as unsatisfactory, stressing the need for the development of good quality guidance, accessible and widely disseminated. DRIVERS AND BARRIERS FOR MANAGING Regarding training needs, only twenty per cent of experts WORK-RELATED STRESS from the Americas, Europe and Central Asia believed that practitioners in their country were appropriately trained. The Experts rated the extent to which certain factors enabled or situation was reported to be worse in Africa (fifteen per cent), hindered the prevention and management of psychosocial risks Arab States (twelve point five per cent) and Asia and the Pacific and work-related stress in their country. (twelve point one per cent). The large majority of experts The following elements were highlighted as the most important (ranging from eighty-nine point seven per cent in Europe and drivers facilitating development and implementation of initiatives: Central Asia, to a hundred per cent in the Arab States) were of availability of resources (such as staff, time or money); the opinion that there is a need in their country for training of integration of measures at the workplace level; understanding practitioners in the prevention and management of work-related and awareness of psychosocial risks and work-related stress; stress. and availability of appropriate tools and methods of intervention. These findings are generally consistent across regions (with the exception of the Arab States in some cases) as shown in Annex 2 (Figure 2.1). Regarding the main barriers, experts highlighted conflict and competition between different governmental departments and lack of clear complementarity of roles as factors which can hinder communication and collaboration between key stakeholders. The following additional barriers were identified: the perception of stakeholders that workplace interventions for managing psychosocial risks are expensive or difficult to handle; lack of trained experts; and the role and influence of

LIII Contributing factors were considered in terms of the level of difficulty they pose and to the extent to which they can act as a barrier to the development and LI Highest concern was reported by experts from the Americas and Europe-Central implementation of initiatives to prevent and manage work-related stress. Asia (hundred per cent), followed by the Asia-Pacific region (eighty-eight point LIV Even if the findings were generally consistent across regions, it should be nine per cent), Africa (seventy-eight point six per cent) and the lowest concern noted that inadequate infrastructure, lack of resources, lack of appropriate was reported by the Arab States (fifty per cent). expertise, poor integration of these issues (both at national and workplace LII Discrimation on the basis of age, gender, ethnic origin, disability, sexual levels) were reported more often by experts based in Africa and the Arab orientation. States.

5. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS 27 stress. Other threats identified were the lack of adherence to FORESIGHT OF FUTURE legal requirements and corruption (e.g. in South America), and lobbying by businesses favouring deregulation (especially in SCENARIOS Europe). Experts were then asked to look 10 years into the future and forecast the most likely scenario, as well as the ideal scenario in DELPHI ROUND 1 their country regarding the prevention of psychosocial risks and The first round of the Delphi was based mostly on open-ended work-related stress in the following key areas: (i) national OSH questions that were thematically analysed. A total of 80 experts laws, regulations, technical standards and collective agreements from 45 countries across the world covering all ILO regions addressing work-related stress and its outcomes; (ii) OSH policies responded to this survey.LV and strategies focusing on psychosocial risks and work-related stress; (iii) technical guidance and awareness campaigns focusing The first four questions were presented within the framework of a on psychosocial risks and work-related stress; (iv) workplace SWOT analysis, identifying strengths, weaknesses, opportunities initiatives focusing on psychosocial risks and work-related stress; and threats in relation to the current situation in the prevention and (v) research and the evidence-base on psychosocial risks of psychosocial risks and work-related stress in their country and work-related stress. A summary of the expected and the (see Annex 2, Table 2.1). As regards the identified strengths, ideal scenarios in relation to these issues is provided in Annex 2, there were differences depending on the context in the country; Table 2.2. for example, in countries where both regulations and voluntary policies existed, participants considered the strength of voluntary In relation to national OSH laws, regulations, technical standards approaches as more relevant. However, legislation, social and collective agreements addressing work-related stress, the dialogue initiatives, a strong evidence-base, awareness-raising, majority of the respondents forecast the introduction of more workplace interventions and appropriately-trained occupational legislation in this area. However, in both the expected and the health services were highlighted as strengths across countries ideal scenarios situations forecast from new legislation to no wherever they existed. Many of the issues reported as strengths change in existing legislation or outright deregulation. A similar were also highlighted as weaknesses in countries where they range of options was identified in relation to OSH policies and were lacking.LVI Even in countries where the policy and practice strategies. The majority of respondents expected the introduction contexts are well developed, reference was made to inadequate of new or additional policies and strategies in this area, while a enforcement of legislation, lack of political will to develop or focus on prevention, on training and competence development implement new initiatives, and the existence of a compensation at national level and sharing of good practices were common culture rather than a truly prevention-oriented culture. Additional elements of the ideal scenario across countries. Options also concerns expressed were the inadequate evaluation of varied in relation to expected scenarios in the development initiatives and a high prevalence of malpractice by consultants of technical guidance and awareness campaigns. In the ideal or practitioners. Exclusion of stress-related illnesses in lists of scenarios guidance for SMEs was frequently reported. Less occupational diseases was identified as a weakness by the optimism and consensus was expressed in relation to the majority of respondents. expected scenarios in the development of workplace initiatives, while in the ideal scenarios several common key issues were In terms of opportunities, the following were mentioned: highlighted across countries, including development of a increased experience and sharing of good practice across healthy organizational culture, psychosocial risk prevention and countries, international policies and codes of practice aimed at management, developing competences at workplace level, promoting responsible business practices, increasing emphasis and management engagement. Incorporating psychosocial risk on organizational sustainability and competitiveness, and prevention as an integral part of OSH management systems coverage and inclusion of these issues in the national OSH was also mentioned by several respondents across countries. system, the public health system or the social security system. Finally, in relation to research and the evidence-base in this These issues were not exclusively reported by respondents in area, respondents in general forecast increased activity, with countries with a stronger policy context and better-developed emphasis on key areas such as psychosocial risk management evidence-base. Finally, several of the threats identified were interventions, and the translation of research into practice. common to respondents. These included a poor economic However, financial and political factors were highlighted climate and increased unemployment, organizational restructuring as possible barriers. In several countries it was hoped that and downsizing, lack of political will, lack of financial resources at international organizations would stimulate research and national or organizational level, an aging workforce, an increase intervention strategies. The ideal scenarios proposed reflected in new forms of work organization, precarious work and non- a high level of consensus across countries on development standard work (e.g. shift-work, temporary work, part-time work). of information systems and databases for sharing of empirical There was a widespread consensus that these issues represent evidence, more cross-country comparisons, and research threats to the prevention of psychosocial risks and work-related evaluating interventions. Experts also identified actions needed at national and workplace levels for the prevention and management of psychosocial risks LV The 80 experts participating in the first round of the Delphi survey were from and work-related stress and indicated how much additional effort Argentina (1), Australia (2), Barbados (1), Belgium (2), Bosnia and Herzegovina (2), Brazil (2), Bulgaria (1), Canada (6) , Chile (1), China (1), Colombia (2), Denmark is required in their country, taking account of various contributory (2), Egypt (1), Estonia (1), Finland (1), France (2), Germany (4), Ghana (1), Grenada factors. Finally they were asked to indicate the priority areas (1), India (1), Italy (2), Ivory Coast (1), Japan (1), Kuwait (1), Libya (1), Malaysia where there is a need for workplace action. An overview of (1), Mexico (3), Netherlands (3), Norway (2), Poland (1), Portugal (1), Romania (1), Saudi Arabia (1), Senegal (1), Singapore (1), Spain (4), Republic of Korea (2), the results regarding both necessary measures at national and Sweden (2), Switzerland (3), Syrian Arab Republic (1), Thailand (1), Tunisia (1), workplace levels and priority actions at workplace level, are Uganda (1), United Kingdom (4), United States (5). As regards the ILO regions, 7 presented in Annex 2 (Table 2.3 and Table 2.4 respectively). A experts were from Africa, 22 from the Americas, 3 from Arab States, 10 from Asia and the Pacific, and 38 from Europe and Central Asia. high level of consensus was reached between experts in relation The group of experts included academics or researchers (43), government to the measures needed, at both national and workplace levels. officials or policymakers (15), health and safety practitioners/consultants (18), and The following issues were reported to be the key measures representatives of social partners, namely employer associations and trade unions (4). The experts’ backgrounds were in different areas, including OSH, ergonomics, needed at national level: developing competences for addressing public health, occupational health psychology, epidemiology, occupational psychosocial risks and work-related stress; enforcement of medicine, nursing, occupational hygiene, management, and law. regulations (where they exist); building consensus between social LVI For example, several of these weaknesses were highlighted by respondents partners; awareness-raising; integration at policy level (e.g. OSH from the Arab States, Africa and, to some extent, Asia and the Pacific, and Latin and health promotion policies); and improving the availability American country respondents.

28 WORKPLACE STRESS: A COLLECTIVE CHALLENGE of intervention tools and assessment methods. At workplace They expected to see OSH legislation including the protection level the following top priorities were identified: integration of the of workers’ mental health across countries in the future. It was prevention of work-related stress in the organizational culture; stressed that awareness of the relevance of OSH legislation for integration of work-related stress prevention in management the protection and promotion of mental health is needed also systems; awareness-raising; introducing policies and preventive in countries where relevant laws already exist. Experts also measures in the workplace; and developing stakeholders’ identified as areas for further improvement the harmonisation competences. and adequate enforcement of legislation across countries, the recognition of stress-related disorders as occupational diseases, and the constraints on enforcement of legislation.LVIII DELPHI ROUND 2 In addition, the following key elements of the ideal scenario were also highlighted: focus on prevention of psychosocial risks The second round was developed on the basis of the results of and promotion of mental health in the workplace as essential the first round of the Delphi survey, with the aim of building further elements of policies; sharing of good practice; and capacity- consensus on key issues and clarifying contributing factors for building of key stakeholders. Awareness and engagement of each area of concern. In total 31 experts responded from 25 policymakers, improved social dialogue, the evidence-based LVII countries across the world covering all ILO regions. The second knowledge and resource deployment were reported to be key round Delphi was mostly based on closed questions. Experts were contributory factors, either facilitating action towards achieving asked to report on the likelihood of a number of scenarios in the the ideal scenario or inhibiting change; a link with the Sustainable key areas for the prevention and management of psychosocial Development Goals agenda was mentioned as an opportunity. risks and work-related stress identified in round 1, as well as the main contributory factors (see Annex 2, Table 2.5). A high level of consensus was expressed in relation to the development of further technical guidance and awareness Awareness and engagement of policymakers, social dialogue, campaigns on psychosocial risks and work-related stress. and the usefulness of translating the evidence-base into practice However, some experts saw such efforts becoming more focused feature prominently as contributing factors across scenario options. on the individual worker rather than on a collective approach to Concerning the key areas of awareness-raising and guidance the improvement of working conditions and primary prevention, development, workplace level initiatives and the evidence-base, especially in countries where preventive efforts were already in other strong contributory factors identified included resources place. In addition, the design of good practice indicators for all and expertise availability, tools and sharing of good practice, and stakeholders and the development of guidance for SMEs were awareness and engagement of stakeholders at enterprise level considered highly desirable. Some differences could be observed (e.g. managers, workers). Respondents also highlighted a culture among experts’ views; for example, more emphasis was placed of prevention at country level as an important contributory factor in on participatory intervention approaches in Asia, and on targeting relation to workplace level initiatives and the suitability of scientific the national audience through mass media in Europe and evidence on the impact of psychosocial risks to health, safety and Australia. productivity for translating evidence-base into practice. A lower degree of optimism and consensus was evident in relation to the expected scenarios for the development of workplace initiatives. In those countries with a stronger policy background, experts forecast that further workplace initiatives FINDINGS AND GLOBAL will be introduced; while in those countries where policies or legislation do not exist or are not sufficiently developed, TRENDS workplace level action was expected to take place mainly as an outcome of governmental action. However, there were some Both the expert opinion survey and the Delphi survey provided cases in which experts foresaw that such initiatives could be useful information for clarifying needs and in highlighting undertaken by enterprises directly, independently of the legal or key drivers and barriers. The Delphi survey also highlighted policy framework. There is also a mix of views on whether these expectations and the ideal scenarios relating to the key areas initiatives would be focused on prevention, with several experts mentioned above. Despite variations across regions, there was a foreseeing an increase of reactive measures. A higher level of high degree of consensus among experts on the ideal scenarios consensus was achieved both in expectations that there will be in a number of key areas, the drivers and barriers to these more initiatives from large enterprises and also in consideration of scenarios, and the necessary actions needed to achieve them. financial constraints as contributing obstacles to action. The key Looking in more detail at the key areas explored in the Delphi, it elements of the ideal scenario for workplace initiatives featured should be noted that experts were quite optimistic in expecting were as follows: increased trade union action, development of a more action in each of them. preventive organizational culture, implementation of integrated approaches (including psychosocial risks in OSH management Regarding legislation and policies, experts generally agreed that systems), evaluation of prevention interventions on psychosocial as awareness increases, there will be further national OSH laws, risk, competence development of key stakeholders, and sharing regulations, technical standards and collective agreements, as of knowledge and practice between large and small enterprises well as OSH policies and strategies addressing psychosocial through networking. Key contributory factors included awareness risks and work-related stress. However, there was evidence of and engagement of policymakers, quality of social dialogue, more pessimism in some European countries where a range and engagement of social partners in this area. Availability of initiatives are already in place. Nevertheless, most experts of resources, expertise, tools and good practices, a culture agreed on the value of a strong policy context emphasizing it of prevention at policy level, awareness and engagement of as a strength where it exists and a weakness where it does not. stakeholders at workplace level (e.g. managers, workers and their representatives) were all also indicated as important contributory factors in relation to workplace level initiatives. LVII The 31 experts participating at the second round of the Delphi survey were from Australia (2), Barbados (1), Belgium (2), Bosnia and Herzegovina (1), Bulgaria In relation to research and the evidence-base in this area, most (1), Chile (1), China (1), Finland (1), Germany (3), Italy (1), Japan (1), Libya (1), Netherlands (1), Poland (1), Romania (1), Saudi Arabia (1), Singapore (1), Republic experts forecast increased activity, with emphasis on key areas of Korea (1), Spain (1), Sweden (2), Syrian Arab Republic (1), Thailand (1), Uganda such as the implementation and evaluation of psychosocial (1), United Kingdom (2), United States (1). Grouped by ILO regions, 2 experts were from Africa, 3 from the Americas, 2 from Arab States, 7 from Asia and the Pacific, and 17 from Europe and Central Asia. The group of experts included academics or researchers (18), government officials LVIII Harmonisation of legislation on OSH exists in EU countries although some of them or policymakers (9), health and safety practitioners (3) and representative of trade have more specific legislation on psychosocial risks and work-related stress than unions (1). others.

5. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS 29 risk management interventions, and the translation of research into practice. The ideal scenarios proposed exhibited strong consensus across countries on several issues, including national 6. WHY IS IT level research and periodic national surveys (if not yet available); development of information systems and databases to show empirical evidence; more cross-country comparisons; research NECESSARY TO evaluating interventions; research on a number of specific issues (such as the link between psychological and physical health, new types of work organization, precarious and non-standard work, HAVE A COLLECTIVE boundary-less work, the business case); and guidance on the translation of such research into practice. The following additional options were reported, mainly by experts from countries with a APPROACH TO stronger policy and practice background: inclusion of this area in research; development of policies and plans at national level with appropriate resource allocation; and research evaluating the PREVENTING AND impact of OSH inspections. Experts from Europe also referred to the need for national research institutes (with appropriate resources) which could conduct relevant studies in the light CONTROLLING THE of closures and budget cuts in many European countries in recent years. Awareness and engagement of policymakers were identified as key contributory factors. Other contributory factors CAUSES OF WORK- identified by experts included quality of social dialogue and engagement of social partners in this area; resource availability; RELATED STRESS? suitability of scientific evidence on the impact of psychosocial risks on health, safety and productivity; and availability of expertise, tools and good practice. The magnitude of the negative impact of work-related stress and It should be noted that there is a very high level of agreement its health outcomes in an important part of the global working between the findings of the Delphi and the previously-conducted population is very evident owing to the wealth of the evidence- expert opinion survey; both indicate the same drivers and barriers base on the prevalence of associated physical and mental health to action and the same priorities to be addressed. With reference disorders at country and regional levels collected over more than to key areas to be addressed, a high level of consensus can be 20 years. Unfortunately, evidence also shows that the incidence observed on the following issues: organizational culture (including and severity are increasing in the present context. poor management and leadership); workload, time pressure and work intensity; work-life balance; organizational change The associated economic costs at national level, even if they and restructuring; job security; precarious work; working time only represent the tip of the iceberg, illustrate how work-related arrangements (including shift work, flexible schedules and rest stress and its health outcomes also have a considerable impact in from work); reward and recognition; control of work; harassment organizational safety, productivity and overall performance. Today (including mobbing or bullying); physical violence (and threat of work-related stress cannot be considered the problem of a few physical violence); and discrimination at work. individuals. It has to be recognised as a collective problem with major implications for the wellbeing of workers, their families and Finally it is important to mention that in different regions there was societies as a whole. a mismatch between the concerns reported by the experts and the perceived priorities for action in their country, highlighting that While acknowledging the role played by researcher and the policy initiatives that have been or are being implemented policymakers in Nordic countries in leading the way, in most may not necessarily be addressing the greatest areas of concern. countries policymakers and social partners have only recently This may be the result of poor awareness and prioritization become involved in the design of legislation and concrete by policymakers owing to their perceptions, or lack of social interventions to tackle the causes at their origin. However, this dialogue and social participation in the design of such policies. demonstrates that consciousness of the need for action has Therefore, particular efforts are still needed to define priorities for increased. There has been growing attention to the assessment action in addressing psychosocial risks and work-related stress and management of psychosocial risks and work-related at national level. stress and to the design of legislation, strategies and policies at international, regional and national levels; the attention of social partners to these issues has also increased; the dissemination of information and awareness-raising campaigns on these topics is greater than in the past; there is also a proliferation of research networks and professional associations willing to design effective interventions to tackle psychosocial risks and work-related stress at workplace level. Employers should be aware of the negative effects of the psychosocial hazards that may affect workers as a result of overwork and lack of control over their tasks, with the consequences of work-related stress and related coping behaviours and health outcomes. Unfortunately, many people are only conscious that a harmful stress level has been reached once its negative effects have affected their work and wellbeing. Making employers and workers aware, informed and competent to address these new risks creates a safe and healthy working environment, builds a positive and constructive preventive culture in the organization, boosts engagement and effectiveness, protects the health and wellbeing of workers, and increases productivity.

30 WORKPLACE STRESS: A COLLECTIVE CHALLENGE In this complex context in which the workplace has become This implies conducting an occupational health practice with a an important source of psychosocial risks and poor work-life multi-faceted approach involving the following: balance, it has also become an ideal venue for addressing those ¡¡ Preventing occupational and other work-related diseases, as psychosocial risks at the origin of work-related stress and its health well as occupational injuries; outcomes. Enterprises should not only focus on an individual response to the problem. A collective approach to the prevention ¡¡ Improving working conditions and work organization; of work-related stress and the promotion of mental health at work ¡¡ Incorporating psychosocial hazards and risks into risk has still to be fostered. Most initiatives on stress management assessment and management measures, and implementing in the workplace have included individual counselling, induction collective preventive measures (as done with other workplace and mentoring of new staff, on-going support by co-workers and hazards and risks) by adapting work organization and working trade unions during unemployment, and individual support in conditions; addressing major life events by building up links with local NGOs. A comprehensive approach to promoting mental health at work, ¡¡ Increasing the coping ability of workers; breaking away from traditional efforts and moving towards new ¡¡ Building up social support systems for workers within the effective responses by addressing both collective and individual workplace; and measures, is necessary. The adoption of collective measures in ¡¡ Assessing the needs of the organization by taking into the workplace can offer support and allow workers to become consideration organizational, individual and individual- more productive without enduring the effects of negative stress. organization interactions when evaluating workers’ health Conversely, it is generally agreed that improving the individual’s requirements. ability to cope with stress can be a valuable complementary strategy as part of the wider, collective and organizational process Workers’ participation in this process is crucial. Workers and of combating work-related stress. Therefore, it is essential to find their representatives should be involved in identifying those innovative ways of handling the causes and the consequences psychosocial risks which they feel cause unnecessary stress of work-related stress with a combination of both collective and in their jobs, and in rating them in such a way as to establish individual measures. priorities for intervention. The assessment should be done in a systematic way and workers should be asked to express their The ideal response to stress is to prevent its occurrence. This may concern about any situation that may be causing stress at work. be achieved by tackling the core of the problem, namely its causes. Joint OSH committees can be instrumental in the management of However, as multiple psychosocial factors can cause stress, it psychosocial risks and work-related stress. ILO experience shows cannot be assessed and managed in isolation. The causes may that the success of an organization is based on its workers and have their origins at work, at home, in the social environment or on its organizational culture. Workers in a safe and supportive in the community. In each of these contexts there may be one or environment feel better and are healthier, which in turn leads to more sources of stress, as well as resources that contribute in reduced absenteeism, enhanced motivation, improved productivity preventing or reducing its impact. Stress may also have an impact and a positive organization’s image. The prevention of occupational in more than one of these contexts. However, as we cannot be accidents and diseases, the promotion of a healthy working life expected to deal with all these issues in these contexts, action at and the building of a preventive culture is a shared responsibility the workplace level should focus on interventions that can prevent of governments, employers and workers, health professionals and or control work-related psychosocial risks. This would have a societies as a whole. positive impact both in the workplace and beyond. The best way to address work-related stress is by means of strategies to tackle the psychosocial hazards at their source in working conditions, the working environment, and in the organizational culture and labour relations of the organization. Once the existence of work-related stress has been recognized and the psychosocial hazards at its origin identified, action to address them at the source should be taken. Therefore, action should be aimed at eliminating as many causes as possible, so that the action taken reduces and prevents future work-related stress. An effective workplace programme to prevent work-related stress requires proper identification of psychosocial risks and assessment of work performance and personal problems resulting from stress. The assessment should be done in a systematic way and workers should be asked to express their concern about any situation that may be causing stress at work. Specific preventive measures aimed at reducing the potential mental health consequences of psychosocial risks and work- related stress should be in place through a risk management approach. A comprehensive OSH management system should ensure improved preventive practices and incorporation of health promotion measures so as to include psychosocial risks in risk assessment and management measures with a view to effectively managing their impact in the same way as with other OSH risks in the workplace.LIX

LIX Risk management is a problem-solving approach to health and safety hazards. It includes both assessment and management of risks. It is an integral part of an enterprise’s OSH management system and contributes to the cycle of continuous improvement of work and working conditions.

6. WHY IS IT NECESSARY TO HAVE A COLLECTIVE APPROACH TO PREVENTING AND CONTROLLING THE CAUSES OF WORK-RELATED STRESS? 31 As a result of the assessment carried out for this report, ILO future CONCLUDING action in this field will aim at: ¡¡ Supporting research initiatives and strategic partnerships in coordination with other international organizations, national REMARKS and regional policymakers and experts networks to support research, awareness raising, education, sharing of good practices, and development of global competencies. ¡¡ Supporting competencies development of key stakeholders The ILO focuses on protecting workers’ health and promoting and translation of research into practice, by means of their wellbeing through improvements in their working conditions promoting education and training through wider application and working environments, and the prevention and control of of ILO tools such as SOLVE and the Stress Checkpoints, and occupational accidents and occupational and work-related additional guidance and training tools including e-learning diseases. programmes in collaboration with key experts. For the ILO, mental health is a state of health and wellbeing (both ¡¡ Supporting the harmonisation of national lists of occupational individually and collectively) in which workers realize their own diseases by providing further guidance on the basis of the ILO abilities, work productively and contribute to their community. In list of occupational diseases. this context, occupational health should “aim at the promotion and maintenance of the highest degree of physical, mental and ¡¡ Supporting integration of psychosocial risk assessment and social wellbeing of workers in all occupations”.LX The fundamental management in OSH management systems, and linking with right to the highest attainable standards of health at work and to a sustainability of interventions. working environment that enables every woman and man in every ¡¡ Facilitate social dialogue at global level for the prevention workplace to live a socially and economically productive life is of work-related stress and its outcomes between ILO one of the ILO’s main objectives. ILO’s contribution to the design constituents. of workplace policies and preventive programmes on OSH takes into account global knowledge gained through the evidence-base ¡¡ Globally promote an integrated approach to prevention and good practice. In times of change in the world of work coping and well-being, combining occupational health and health successfully with psychosocial risks in the workplace is essential promotion in collaboration with WHO. for protecting the health and wellbeing of workers while enhancing the productivity of organizations. The ILO has a long tradition of developing national and workplace policies to protect workers’ health and wellbeing and at the same time enhance productivity. The ILO’s comparative advantage in tackling mental health at work lies in its experience in using social dialogue in the implementation of successful national, workplace and community initiatives addressing these problems by means of capacity-building in Decent Work Country Programmes in member States, with the involvement of employers, workers and their representatives, OSH practitioners, governments, policymakers, public services and NGOs. By providing mechanisms for addressing psychosocial risks at work through incorporation of preventive and health promotion measures, the ILO contributes to a more decent and human world of work.

LX According to the comprehensive definition adopted by the Joint ILO–WHO Committee on Occupational Health at its First Session (1950) and revised at its 12th Session (1995); see ILO, Joint ILO/WHO Committee on Occupational Health. Report of the Committee, 12th Session, Geneva, 5-7 April 1995.

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References 35 ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS

TABLE 1.1 · QUESTIONNAIRES TO ASSESS PSYCHOSOCIAL RISKS, WORK-RELATED STRESS AND BURNOUT

BURNOUT MEASURE (BM) (PINES & ARONSON 1988) [1981] TOPICS Burnout – Physical exhaustion, emotional exhaustion & mental exhaustion LANGUAGES Dutch, English

CANEVAS (DELAUNOIS ET AL. 2002) [1995] TOPICS Company stress diagnosis at given moment. Initial global evaluation of situation (service, department, company, organization) in terms of risks/ confirmation of stress LANGUAGE French

COPENHAGEN PSYCHOSOCIAL QUESTIONNAIRE (COPSOQ) (KRISTENSEN ET AL. 2005) [2002]

TOPICS Psychosocial factors, stress, individual health/wellbeing, personality factors (coping style, sense of coherence, etc.) LANGUAGES Chinese, Croatian, Danish, Dutch, English, Flemish, German, Malaysian, Norwegian, Persian, Portuguese, Spanish, Swedish

COPENHAGEN BURNOUT INVERNTORY (CBI) (KRISTENSEN ET AL., 2005) [2005]

TOPICS Burnout – Fatigue and exhaustion LANGUAGES Cantonese, Danish, English, Finnish, French, Japanese, Mandarin, Slovenian, Swedish

EFFORT-REWARD IMBALANCE (ERI) (SIEGRIST ET AL. 2004) [1994] TOPICS Effort-reward relations as determinants of well-being LANGUAGES Chinese, Czech, Danish, Dutch, English, Finish, French, German, Italian, Japanese, Norwegian, Polish, Portuguese, Russian, Spanish, Swedish

GENERAL NORDIC QUESTIONNAIRE (QPS NORDIC) (LINDSTROM 2002) [2000] TOPICS Psychological/social factors (as potential determinants of motivation, health and well-being) LANGUAGES Danish, English, Finnish, Greek, Icelandic, Norwegian, Swedish

HSE INDICATOR TOOL (HSE) [2004] TOPICS Conditions known to be potential determinants of work-related stress LANGUAGES Arabic, Bengali, Chinese, English, Farsi, Gujarati, Hindi, Hungarian, Kurdish, Pashto, Polish, Punjabi, Russian, Tamil, Turkish, Urdu, Welsh

JOB CHARACTERISTICS INDEX (JCI) (SIMS ET AL. 1976)

TOPICS Subjectively perceived job characteristics LANGUAGE English

JOB CONTENT QUESTIONNAIRE (JCQ) (KARASEK ET AL. 1998) [1985] TOPICS Content of respondents’ work tasks using high-demand/low-control/low-support model of job strain development LANGUAGES Bulgarian, Chinese, Czech, Dutch, English, Flemish, French, German, Greek, Iceland, Italian, Japanese, Korean, Malaysian, Norwegian, Polish, Portuguese, Russian, Spanish, Swedish, Thai

JOB DIAGNOSTIC SURVEY (JDS) (HACKMAN AND OLDHAM 1975) [1975] TOPICS Subjectively perceived job characteristics LANGUAGE English

JOB STRESS SURVEY (JSS) (VAGG AND SPIELBERG 1999) [1994] TOPICS Severity/frequency of working conditions LANGUAGES English, French

MASLACH BURNOUT INVENTORY (MBI) (MASLACH ET AL. 1996) [1981]

TOPICS Burnout – emotional exhaustion, depersonalization, and reduced personal accomplishment (relabelled as: Exhaustion, Cynicism and Professional competence LANGUAGES Dutch, English, Greek, others

MULTIDIMENSIONAL ORGANIZATIONAL HEALTH QUESTIONNAIRE (MOHQ) (AVALLONE AND PAMPLOMATAS 2005) [2003] TOPICS Indicators of organizational wellbeing LANGUAGE Italian

NIOSH GENERIC JOB STRESS QUESTIONNAIRE (HURRELL AND MCLANEY 1988) [1988] TOPICS Job characteristics, psychosocial factors, physical conditions, safety hazards, stress, health and job satisfaction LANGUAGES Chinese, English, Japanese, Korean, Spanish

NOVA WEBA QUESTIONNAIRE (HUYS AND DE RICK 2005) [1992] TOPICS Stress-related risks LANGUAGE Dutch (CONT.) ››

36 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 1.1 · QUESTIONNAIRES TO ASSESS PSYCHOSOCIAL RISKS, WORK-RELATED STRESS AND BURNOUT (CONT.)

OCCUPATIONAL STRESS INDEX (OSI) (BELKIC 2000) [2003] TOPICS Occupational stress burdens LANGUAGES Bosnian, English, Serbian, Swedish

OCCUPATIONAL STRESS INDICATOR (OSIND) (COOPER ET AL. 1988) [1988] TOPICS Stressful working conditions LANGUAGES Chinese, English, Italian

OCCUPATIONAL STRESS INVENTORY (OSINV) (OSIPOW 1992) [1980] TOPICS Occupational adjustment in terms of job stressors, personal strain, and coping LANGUAGES Chinese, English

OCCUPATIONAL STRESS QUESTIONNAIRE (ELO ET AL. 1998) [1992] TOPICS Occupational stress: perceived work/environmental stressors, individual stress reactions, and organizational influence LANGUAGES English, Finnish

OLDENBURG BURNOUT INVENTORY (OLBI) (HALBESLEBEN AND DEMEROUTI 2005) [1999] TOPICS Burnout – exhaustion and disengagement LANGUAGES English, German, Greek

POSITION ANALYSIS QUESTIONNAIRE (PAQ) (MCCORMICK ET AL. 1972) [1972] TOPICS Position and job stress evaluations LANGUAGE English

PRESSURE MANAGEMENT INDICATOR (WILLIAMS AND COOPER 1998) [1998] TOPICS Workplace pressure LANGUAGES English, “over 20 languages” NOTES Developed from Occupational Stress Indicator

PSYCHOSOCIAL WORKING CONDITIONS (PWC) (WIDERSZAL-BAZYL AND CIESLAK 2000) [2000] TOPICS Stress impact of psychosocial working conditions LANGUAGE Polish

STRESS DIAGNOSTIC SURVEY (SDS) (IVANCEVICH ET AL. 1983) [1983] TOPICS Identify specific areas of high job stress in work environment LANGUAGE English

STRESS D’ORGANISATION QUESTIONNAIRE (VOS-D) (PREVENT 2005) [1986] TOPICS Work conditions to facilitate task accomplishment for challenged workers LANGUAGES Dutch, French

STRESS PROFILE (SETTERLIND AND LARSON 1995) [1995] TOPICS Psychosocial work environment LANGUAGES: Danish, English, Estonian, Finnish, French German, Norwegian

STRESS RISK ASSESSMENT QUESTIONNAIRE (SRA) (STRESSRISK.COM) [2003] TOPICS Workplace stress LANGUAGE English

TRAVAIL ET SANTÉ (VAG) (CONSEIL NATIONAL DU TRAVAIL (CNT) 2004; FÉDÉRATION GÉNÉRALE DU TRAVAIL DE BELGIQUE (FGTB) 2002) [1993] TOPICS Characteristics of workplace stress LANGUAGES Dutch, French

TRIPOD SIGMA QUESTIONNAIRE (WIEZER AND NELEMANS 2005) [2003] TOPICS Stress management tool LANGUAGE Dutch

VRAGENLIJST BELEVING EN BEOORDELING VAN DE ARBEID (VBBA) (VAN VELDHOVEN AND BROERSEN 2003) [1994] TOPICS Causes and consequences of work-environment factors LANGUAGES Dutch, French (Questionnaire sur le Véçu du Travail; VT)

WORK ENVIRONMENT SCALE (WES) (MOOS 1981) [1981]

TOPICS Social climate of work units LANGUAGE English

WORKING CONDITIONS AND CONTROL QUESTIONNAIRE (WOCCQ) (DE KEYSER AND HANSEZ 1996) [2001] TOPICS Psychosocial risk and workers’ job-control LANGUAGES Dutch, English, French

ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS 37 TABLE 1.2 · TOOLS FOR THE ASSESSMENT, MANAGEMENT AND PREVENTION OF PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS

DOSSIER RISQUES PSYCHOSOCIAUX TYPE Guide DEVELOPED BY Institut national de recherche et de sécurité (INRS), France LANGUAGE French LINK www.inrs.fr/risques/psychosociaux.html ERGO.ONLINE TYPE On line platform DEVELOPED BY Hessian Ministry of Social Affairs, Germany LANGUAGE German LINK http://www.ergo-online.de/ FICHAS DE PREVENCIÓN DE RIESGOS PSICOSOCIALES TYPE Guide / Fact sheet DEVELOPED BY Observatorio de riesgos psicosociales de la Unión General de Trabajadores (UGT), Spain LANGUAGE Spanish LINK http://portal.ugt.org/saludlaboral/observatorio/fichas/fichas.htm FPSICO 3.1 TYPE On line platform DEVELOPED BY Instituto Nacional de Seguridad e Higiene en el Trabajo (INSHT), Spain LANGUAGE Spanish LINK http://www.insht.es/portal/site/Insht/menuitem.1f1a3bc79ab34c578c2e8884060961ca/?vgnextoid=0b3deb0844790310VgnVCM1000008130110a RCRD&vgnextchannel=ac18b12ff8d81110VgnVCM100000dc0ca8c0RCRD

GOOD WORK. GOOD HEALTH. IMPROVING THE MENTAL WELLBEING OF WORKERS WITHIN THE TELECOMMUNICATIONS SECTORS. TYPE Guide DEVELOPED BY European Telecommunication Network Operators Association (ETNO) and UNI global union Europa, EU LANGUAGE English LINK https://www.etno.eu/datas/publications/studies/etno-goodpracticeguidelines-en.pdf GUIDANCE FOR THE PREVENTION OF STRESS AND VIOLENCE AT THE WORKPLACE TYPE Guide DEVELOPED BY Department of Occupational Safety and Health (DOSH), Malaysia LANGUAGES English, Malaysian LINK http://www.dosh.gov.my/index.php?option=com_docman&task=cat_view&gid=16&Itemid=179&lang=en

GUIDANCE ON WORK-RELATED STRESS – SPICE OF LIFE OR KISS OF DEATH? TYPE Guide DEVELOPED BY European Commission, EU LANGUAGES English, French, German, Italian, Spanish LINK https://osha.europa.eu/en/legislation/guidelines/guidance-on-work-related-stress GUIDE PRATIQUE DU DÉLÈGUE À LA SÉCURITÉ. AGIR AU QUOTIDIEN, AUX COTES DES SALARIÉS. LA PRÉVENTION DES RISQUES PSYCHOSOCIAUX. TYPE Guide DEVELOPED BY Chambre des salariés (CSL), Luxembourg LANGUAGE French LINK http://www.csl.lu/component/rubberdoc/doc/2092/raw HEADS UP TYPE On line platform DEVELOPED BY Mentally Healthy Workplace Alliance and Beyondblue, Australia LANGUAGE English LINK https://www.headsup.org.au/ HEALTH & SAFETY FACT SHEETS (OSH ANSWERS) TYPE On line resources DEVELOPED BY Canadian Centre for Occupational Health and Safety (CCOHS), Canada LANGUAGES English, French LINK http://www.ccohs.ca/topics/hazards/psychosocial/stress/

HERRAMIENTAS DE GESTIÓN DE LOS RIESGOS PSICOSOCIALES EN EL SECTOR EDUCATIVO TYPE On line platform DEVELOPED BY Fundación para la prevención de riesgos laborales, Spain LANGUAGE Spanish LINK http://www.prl-sectoreducativo.es/introduccion.html (CONT.) ›› 38 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 1.2 · TOOLS FOR THE ASSESSMENT, MANAGEMENT AND PREVENTION OF PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS (CONT.)

IMPULS-TEST: ANALYSIS OF STRESSORS AND HUMAN RESOURCES COMPANIES TYPE On line platform DEVELOPED BY Austrian Social Insurance for Occupational Risks (AUVA), Austria LANGUAGE German LINK http://www.impulstest.at/ ISTAS 21 TYPE Questionnaire and guide DEVELOPED BY Instituto Sindical de Trabajo, Ambiente y Salud (ISTAS), Spain LANGUAGES Spanish, Catalan, Galician LINK http://www.copsoq.istas21.net/ LERNEN UND GESUNDHEIT - STRESS TYPE On line platform DEVELOPED BY Deutsche Gesetzliche Unfallversicherung (DGUV), Germany LANGUAGE German LINK http://www.dguv-lug.de/845697.php MANAGEMENT STANDARDS FOR WORK RELATED STRESS TYPE On line platform DEVELOPED BY Health and Safety Executive (HSE), United Kingdom LANGUAGE English LINK http://www.hse.gov.uk/stress/standards/ MENTAL HEALTH ACTION CHECKLIST, MHACL TYPE Checklist DEVELOPED BY Yoshikawa, Kawakami, Kogi, Tsutsumi, Shimazu, Nagami, Shimazu, Japan LANGUAGE Japanese LINK https://www.jstage.jst.go.jp/article/sangyoeisei/49/4/49_4_127/_article/-char/ja/ MENTAL HEALTH AND WELLBEING: A LINE MANAGER’S GUIDE TYPE Guide DEVELOPED BY Irish Business and Employers Confederation (IBEC), Ireland LANGUAGE English LINK https://www.ibec.ie/IBEC/DFB.nsf/vPages/Social_affairs~Resources~mental-health-and-wellbeing-a-line-manager’s-guide-04-10- 2012?OpenDocument#.VjjbYLerRph NAPO IN…WHEN STRESS STRIKES TYPE Video DEVELOPED BY Napo Consortium, EU LANGUAGES Multilingual LINK https://www.napofilm.net/en/napos-films/napo-when-stress-strikes OHS REPS - STRESS TYPE On line platform DEVELOPED BY Victorian Trades Hall Council, Australia LANGUAGES English LINK http://www.ohsrep.org.au/hazards/stress ONLINE INTERACTIVE RISK ASSESSMENT – OIRA TYPE On line platform DEVELOPED BY European Agency for Safety and Health at Work (EU OSHA), EU LANGUAGES Bulgarian, Czech, Danish, Dutch, English, Estonian, Finnish, French, German, Greek, Hungarian, Icelandic, Irish, Italian, Latvian, Lithuanian, Maltese, Norwegian, Polish, Portuguese, Romanian, Slovak, Slovenian, Spanish, Swedish LINK http://www.oiraproject.eu/about PEOPLE AT WORK TYPE On line platform DEVELOPED BY University of Queensland and Australian National University, Australia LANGUAGE English LINK www.peopleatworkproject.com.au PRÉVENIR LES RISQUES PSYCHOSOCIAUX : LA MÉTHODE ANACT TYPE Guide DEVELOPED BY Agence Nationale pour l’Amélioration des Conditions de Travail (ANACT), France LANGUAGE French LINK http://www.anact.fr/prevenir-les-risques-psychosociaux-la-methode-anact (CONT.) ››

ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS 39 TABLE 1.2 · TOOLS FOR THE ASSESSMENT, MANAGEMENT AND PREVENTION OF PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS (CONT.)

PRIMA- EF: GUIDANCE ON THE EUROPEAN FRAMEWORK FOR PSYCHOSOCIAL RISK MANAGEMENT: A RESOURCE FOR EMPLOYERS AND WORKER REPRESENTATIVES TYPE Guide DEVELOPED BY PRIMA-EF Consortium, EU LANGUAGES Dutch, English, Finnish, German, Italian, Polish LINK http://www.prima-ef.org/prima-ef-guide.html PROMOTING MENTAL WELLBEING AT WORK TYPE Guide DEVELOPED BY National Institute for Health and Care Excellence (NICE), United Kingdom LANGUAGE English LINK http://pathways.nice.org.uk/pathways/promoting-mental-wellbeing-at-work PSYRES FACTSHEETS ON RESTRUCTURING AND EMPLOYEE WELL-BEING TYPE Guide DEVELOPED BY PSYRES Consortium, EU LANGUAGES Danish, Dutch, English, Finnish, Polish LINK https://www.ciop.pl/CIOPPortalWAR/appmanager/ciop/ en;jsessionid=Dv7pTlyRcKqLpY2GxhLJ6lQKR2Q5BQ4NkJ8H521mQ6L5FnXpJcYH!-1104088908?_nfpb=true&_ pageLabel=P21400150341386920320767&html_tresc_root_id=28571&html_tresc_id=28612&html_klucz=28571&html_klucz_spis= PSR RAIL. A GUIDE TO IDENTIFYING AND PREVENTING PSYCHOSOCIAL RISKS AT WORK IN THE RAILWAY SEC TOR TYPE Guide DEVELOPED BY European Transport Workers’ Federation (ETF) and the Community of European Railways and Infrastructure Companies (CER), EU LANGUAGES English, French, German LINK http://www.etf-europe.org/etf-3895.cfm RESPECT AT WORK TYPE On line platform DEVELOPED BY Federal Public Service Employment, Labour and Social Dialogue, Belgium LANGUAGES Dutch, French LINK www.respectautravail.be SAFETY & WORK TYPE On line platform DEVELOPED BY International Social Security Association (ISSA) LANGUAGE English LINK http://safety-work.org/en/pages/topics/stress.html SOLVE: INTEGRATING HEALTH PROMOTION INTO WORKPLACE OSH POLICIES TYPE Training package DEVELOPED BY International Labour Organization (ILO) LANGUAGES English, French, Spanish LINK http://www.ilo.org/safework/info/instr/WCMS_178438/lang--en/index.htm SOBANE TYPE On line platform DEVELOPED BY Belgian Ministry of Labour and the European Social Fund. LANGUAGES Dutch, French LINK http://www.sobane.be/sobane/index.aspx STRESS PREVENTION CHECKPOINTS TYPE Checklist DEVELOPED BY International Labour Organization (ILO) LANGUAGES English, French, Spanish LINK http://www.ilo.org/safework/info/instr/WCMS_177108/lang--en/index.htm STOP IT! PREVENTING THIRD PARTY VIOLENCE IN COMMERCE. A TOOLKIT TYPE Guide DEVELOPED BY UNI global union Europa (Commerce and EuroCommerce), EU LANGUAGES English, French, German LINK http://www.eurocommerce.eu/policy-areas/social-dialogue/policy-updates/2013/projects/third-party-violence/third-party-violence.aspx STRESS, HARASSMENT AND VIOLENCE TYPE On line resources DEVELOPED BY European Trade Union Institute (ETUI), EU LANGUAGES English, French LINK http://www.etui.org/Topics/Health-Safety/Stress-harassment-and-violence (CONT.) ››

40 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 1.2 · TOOLS FOR THE ASSESSMENT, MANAGEMENT AND PREVENTION OF PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS (CONT.)

STRESSNOSTRESS TYPE On line platform DEVELOPED BY SECO, SUVA and Promotion Santé Suisse, Switzerland LANGUAGES French, German, Italian LINK www.stressnostress.ch TOOL FOR IDENTIFYING PSYCHOSOCIAL RISK FACTORS IN THE WORKPLACE TYPE Checklist DEVELOPED BY Institut national de santé publique du Québec (INSPQ), Canada LANGUAGES English, French LINK https://www.inspq.qc.ca/en/tool-psychosocial-risk-factors TRAVAILLER MIEUX – RISQUES PSYCHOSOCIAUX TYPE On line platform DEVELOPED BY Ministère du Travail, de l’Emploi, de la Formation professionnelle et du Dialogue social, France LANGUAGE French LINK http://travail-emploi.gouv.fr/sante-au-travail/prevention-des-risques/risques-psychosociaux/ TROUSSE LA SANTÉ PSYCHOLOGIQUE AU TRAVAIL TYPE Guide DEVELOPED BY University of Laval, Canada LANGUAGES English, French LINK http://www.cgsst.com/eng/publications-sante-psychologique-travail/trousse-la-sante-psychologique-au-travail.asp WEBA (WEBA-METHODIEK : EEN INSTRUMENT VOOR HET BEOORDELEN VAN KWALITEIT VAN DE ARBEID) TYPE Report / Assessment tool DEVELOPED BY Dutch Institute of Preventive Healthcare, the Netherlands LANGUAGE Dutch LINK http://repository.tudelft.nl/view/tno/uuid%3Aeeefdd10-e596-4a2d-a4af-ffb86cf743a3/ WELL-BEING AT WORK TYPE On line resources DEVELOPED BY Finnish Institute of Occupational Health (FIOH), Finland LANGUAGES English, Finnish, Swedish LINK http://www.ttl.fi/sv/valmaende/Sidor/default.aspx WORK IN TUNE WITH LIFE TYPE Guide DEVELOPED BY European Network for Workplace Health Promotion (ENWHP), EU LANGUAGES English, German LINK http://www.enwhp.org/enwhp-initiatives/current-initiative-work-in-tune-with-life/mental-health-at-the-workplace.html WORK-RELATED STRESS TIP SHEETS TYPE Guide DEVELOPED BY Work Cover Authority of New South Wales, Australia LANGUAGE English LINK http://www.workcover.nsw.gov.au/health-and-safety/safety-topics-a-z/mental-health/stress-tip-sheets-accordion/overview-of-work- related-stress-tip-sheet-one WORKPLACE SAFETY AND HEALTH GUIDELINES. HEALTHCARE TYPE Guide DEVELOPED BY Workplace Safety and Health (WSH) Council and the Ministry of Manpower, Singapore LANGUAGE English LINK https://www.wshc.sg/files/wshc/upload/cms/file/2015/WSH_Guidelines_Healthcare.pdf WORKPLACE STRESS TYPE On line platform DEVELOPED BY Health and Safety Authority (HSA), Ireland LANGUAGE English LINK http://www.hsa.ie/eng/Workplace_Health/Workplace_Stress/ WORK WELL MODEL TYPE On line platform DEVELOPED BY Business in the Community (BITC), United Kingdom LANGUAGE English LINK http://www.bitc.org.uk/programmes/wellbeing/workwell-model

ANNEX 1. ASSESSMENT AND INTERVENTION TOOLS 41 ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS

FIGURE 2.1 · FACTORS ‘CRITICAL TO THE SUCCESS OF THE INITIATIVES’, BY ILO REGION

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 subject partners Scientific evidence expertise regulations Awareness Awareness of the issue on the issue The sensitivity tools/methods the policy level Africa the enterprise level formalized systems) Americas as staff, time or money as staff,

Availability of appropriate of appropriate Availability of appropriate Availability Arab States Adequate enforcement of Adequate enforcement Specific regulations on the Specific regulations Consensus between social Infrastructure (e.g. services, Infrastructure Availability of resources such of resources Availability Integration of these issues at Integration of these issues at Asia and Pacific Understanding of psychosocial factors and work-related stress factors and work-related Europe and Central Asia

Note: Based on aggregated data at the country level

FIGURE 2.2 · BARRIERS FOR THE DEVELOPMENT/IMPLEMENTATION OF INITIATIVES, BY ILO REGION

5 4.5 4 3.5 3 2.5 2 1.5 1 0.5 0 evidence expertise regulations the subject of the issue on the issue The sensitivity time or money tools/methods social partners Africa at the policy level Lack of awareness Lack of awareness work-related stress work-related Lack of appropriate Lack of appropriate Insufficient scientific Insufficient Americas at the enterprise level Limited understanding of psychosocial factors and Arab States Inadequate enforcement of Inadequate enforcement Lack of infrastructures (e.g. Lack of infrastructures Unavailability of appropriate Unavailability of appropriate Lack of consensus between

services, formalized systems) Asia and Pacific Lack of specific regulations on Lack of specific regulations Poor integration of these issues Poor integration of these issues Lack of resources such as staff, such as staff, Lack of resources Europe and Central Asia

Note: Based on aggregated data at the country level

42 WORKPLACE STRESS: A COLLECTIVE CHALLENGE

Modifications of laws not aimed at prevention but Modifications of laws not aimed at prevention focussing on compensation Poor economic climate and increasing unemployment Poor economic climate and increasing Organizational restructuring and downsizing leading to Organizational restructuring job losses Aging workforce Lack of political will Lobbying by businesses to deregulate Lack of financial resources at both the national and Lack of financial resources workplace level Stigma linked to mental health Insufficient surveillance and enforcement of legislation surveillance and enforcement Insufficient Lack of initiatives aimed at developing technical capacity to deal with issues within the enterprise Weak social dialogue and conflicting opinions of trade Weak unions and employer associations Apathetic culture Inadequate social security provisions Increase in new forms of work organization, precarious in new forms of work organization, precarious Increase work (shift-work, temporary work, work/non-standard part-time work, etc.) Lack of adherence to legal requirements and corruption to legal requirements Lack of adherence ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ THREATS ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ Growing interest in these areas in policy research and in policy research in these areas interest Growing practice Sectoral initiatives New legislation/updates of existing legislation and guidelines Development of new standards New social dialogue initiatives availability of new training courses Increasing including number of trained professionals, Increasing occupational health psychologists, ergonomists, etc. of these issues public awareness Increasing of financial costs associated with awareness Increased these issues for individuals, organizations and society evidence of psychosocial risk management Increasing lower leading to benefits such as higher productivity, sickness absence, etc. in the compensation being granted for cases Increase stress of mental illness caused by work-related of high quality research Availability worker involvement Increased experience and good practice sharing Increased countries across International policies and codes of practice aimed at business practices responsible promoting emphasis on organizational sustainability Increasing and competitiveness Coverage and inclusion of these issues in the national public health system ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ OPPORTUNITIES ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ Absence of legislation or lack specific of legislation Inadequate enforcement Lack of political will to develop/implement new initiatives of issues Lack of awareness Lack of trained/qualified professionals in this area Lack of funding for research Lack of epidemiological data and statistics Emphasis on individual attributes (coping skills, lifestyle etc.) rather than on working conditions including the psychosocial work environment of compensation rather than prevention Culture associated with mental Stigma and social prejudice stress health and work-related trade unions or employee voice Weak Lack of guidance for risk assessment and inadequate follow up Over emphasis on voluntary/non-regulatory approaches Lack of employer involvement and participation Inadequate evaluation of initiatives, highlighting on investment benefits, return Lack of collaboration between policymakers and researchers/academics of malpractice by consultants/ High prevalence practitioners Social security does not cover workers for stress- illnesses in illnesses / Exclusion of stress-related related list of occupational diseases aimed at Lack of national strategies/programmes also focusing on SMEs, self-employed and prevention, informal workers ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ WEAKNESSES ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ OF PSYCHOSOCIAL RISKS AND WORK-RELATED STRESS IN RELATION WITH THE SITUATION IN THEIR COUNTRY IN THEIR SITUATION THE WITH IN RELATION STRESS RISKS AND WORK-RELATED OF PSYCHOSOCIAL TABLE 2.1 · DELPHI ROUND 1: STRENGTHS, WEAKNESSES, OPPORTUNITIES AND THREATS IDENTIFIED FOR THE PREVENTION PREVENTION THE FOR IDENTIFIED AND THREATS WEAKNESSES, OPPORTUNITIES ROUND 1: STRENGTHS, 2.1 · DELPHI TABLE Specific legal requirements (e.g. psychosocial Specific legal requirements risk assessment obligatory part of workplace assessment, legislation on harassment/bullying at work) illnesses in list of Inclusion of stress-related occupational diseases and standards Development of non-regulatory guidance and inspectors for Initiatives taken by regulators and mental health psychosocial risk prevention in the workplace promotion initiatives, social dialogue Tripartite Stakeholder involvement and participation of epidemiological data and statistics Availability evidence-base and stronger research Increased Collaboration between policymakers and researchers/ academics raising campaigns, events and initiatives Awareness for all of training courses in this area Availability stakeholders Qualified and trained occupational health services (not but also prevention) only on rehabilitation of technical support in this area Availability ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ STRENGTHS

ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS 43 ›› (CONT.) (CONT.) No change in existing legislation and policies principles on the basis of prevention of psychosocial hazards of new legislation covering the identification, monitoring and control Introduction covering the identification, monitoring and and tripartite agreements codes of practice, standards, of new legislation, approved Introduction principles on the basis of prevention of psychosocial hazards control age) discrimination, retirement of new legislation but only on specific issues (such as harassment and bullying, Introduction or international level at regional based on prevention Adoption of harmonised, common set laws and regulations primary prevention Update of existing legislation towards employment for small enterprises, the self-employed and non-regular Update of existing legislation to include provisions to good practice and according existing legislation appropriately Courts interpreting of existing legislation No new legislation but adequate enforcement to implement existing legislation appropriately No new legislation but political will and deployment of adequate resources of including guidance on the identification, monitoring and control and agreements No new legislation but development of voluntary standards principles on the basis of prevention psychosocial hazards Compliance with UN and ILO standards illnesses as occupational diseases Recognition of stress-related as an essential part of social dialogue working conditions including the psychosocial work environment Social partners treating and empowerment of employees Support of workers’ representatives Evaluation of existing legislation and policies to drive improvement (less legislation and other policies) Deregulation No change psychosocial hazards towards traditional focus on physical hazards of OSH policies away from Update and reorientation in the workplace collaboration and mental health promotion Development of national strategies focussing on psychosocial risk prevention with all key stakeholders in the workplace collaboration and mental health promotion strategies focussing on psychosocial risk prevention Development of regional with all key stakeholders in the workplace collaboration and mental health promotion Development of sectoral strategies focussing on psychosocial risk prevention with all key stakeholders for key stakeholders (e.g. risk prevention Development of strategies focussing on training and competency development psychosocial managers, social partners and occupational health services) with sustainability and mental health promotion psychosocial risk prevention Development of strategies linking the work environment, (economic, social, human and demographic) in the workplace by majority of and mental health promotion Adoption of policies and strategies on psychosocial risk prevention organizations countries on the basis of good practice across and mental health promotion Sharing knowledge and practice in psychosocial risk prevention examples deployment resource the implementation of knowledge into practice supported by appropriate Strategies to promote education) Mental health in the workplace should be an essential part of all policies (e.g. employment, public health, economy, ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ IDEAL SCENARIOS TABLE 2.2 · DELPHI ROUND 1: EXPECTED AND IDEAL SCENARIOS ON KEY THEMES ON KEY SCENARIOS ROUND 1: EXPECTED AND IDEAL 2.2 · DELPHI TABLE No change new policies and action to introduce government/regional More stress strategies focussing on psychosocial risks and work-related action to extend/update policies and government/regional More raising and dissemination of good strategies to focus on awareness practices action at workplace level action but more No government/regional Less policies and strategies in this area No change (due to political and/or financial reasons, weak social No change (due to political and/or financial reasons, dialogue, weak position of employees in labour market) and collective legislation and other policies such as standards More agreements legislation but only on specific issues (such as harassment and More age) bullying, discrimination, retirement primary prevention Update of legislation towards voluntary standards No new legislation but more workplace initiatives No new legislation or other policies but more (less legislation and other policies) Deregulation ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ EXPECTED SCENARIOS OSH policies and strategies focussing on psychosocial risks and work-related stress KEY THEMES National OSH laws, regulations, technical standards and collective agreements dealing with work-related stress

44 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 2.2 · DELPHI ROUND 1: EXPECTED AND IDEAL SCENARIOS ON KEY THEMES (CONT.) TABLE No change stigma in this area and reducing Development of campaigns and guidance on prevention Development of campaigns and guidance on psychosocial risk assessment management including definition good practice ind icators services personnel, policymakers) for all stakeholders (including employees, managers, social partners, occupational health Development of campaigns and guidance on interventions using participatory approaches Development of evidence-based sectoral guidance in this area raising campaigns on key issues (e.g. risk assessment, business case, link of psychosocial focussed technical guidance and awareness More risks and physical health) raising campaigns for small and medium-sized enterprises focussed technical guidance and awareness More various mass media raising campaigns targeted to the national audience through Awareness society (linked a competitive economy and healthy productive raising on the link between a healthy and motivated workforce, Awareness to sustainability) and mental health fertilization of knowledge and practice in psychosocial risk prevention raising and guidance on the basis of cross Awareness countries on the basis of good practice examples and case studies across promotion No change in the workplace and mental health promotion initiatives on psychosocial risk prevention Workplace-level and developing a healthy organizational culture initiatives focussing on prevention Workplace-level and mental health for psychosocial risk prevention initiatives focussing on the implementation and evaluation of interventions Workplace-level in the workplace promotion stigma and develop competencies of employees managers, using easily accessible reduce initiatives to raise awareness, Workplace-level materials psychosocial risks and promote to prevent initiatives will include joint committees (employees and managers) agreements Workplace-level mental health in the workplace applicable to all sizes of enterprises participatory approaches initiatives on proactive, Workplace-level as an integral part to OSH (OSH management systems) including psychosocial risk prevention Implementation of an integrated approach level networking at local, regional Sharing knowledge and good practices between large small enterprises through but not only due to regulations working conditions including the psychosocial work environment Management will be engaged in improving and organizational productivity health and engagement, improved workforce positive benefits such as improved because they recognize performance trade unions at the workplace level in this area action from More No change deployment) including periodic national surveys resource appropriate (through National level research research that conduct relevant resources) institutes (with appropriate Ensuring the existence of national research institutes and other key stakeholders (e.g. labour inspectors, occupational health services, social Collaboration between national OSH research partners) in this area allocation resource and Development policies plans at national level with appropriate in Research Inclusion of this area Development of information systems/databases to show empirical evidence and allow benchmarking longitudinal studies in this area More (if possible) in this area RCTs More focussing on SMEs research More fertilization of knowledge and practice comparisons to allow cross and cross-cultural on cross-country research More in the workplace and mental health promotion on the implementation and evaluation of psychosocial risk prevention Research evaluating OSH inspections with a focus on this area Research /non- on specific issues such as the link between psychological and physical health, new types of work organization, precarious research More work, boundaryless the business case, interventions standard barriers to action) (and especially removing into practice in this area of research Translation ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ IDEAL SCENARIOS No change legislation is put only if more initiatives to be introduced Workplace-level into place only if business case is initiatives to be introduced Workplace-level established further trade only through initiatives to be introduced Workplace-level union action only in specific sectors initiatives to be introduced Workplace-level only in large enterprises initiatives to be introduced Workplace-level focussing on prevention workplace-level initiatives to be introduced More and developing a healthy organizational culture but focussing on the workplace-level initiatives to be introduced More individual and wellness (not on the workplace prevention) on focussed workplace-level initiatives to be introduced More issues such as risk assessment, surveillance, training, competency development (due to political and financial Less workplace-level initiatives in this area etc.) reasons, No change deployment for research) resource at national level (more research More or organizational level but not at national level (regional research More research) focussing on specific issues (such as psychosocial research More risk assessment, the link between psychological and physical health, interventions) into practice initiatives on translating research More etc.) (due to political and financial reasons, Less research No change and developing guidance government More action on raising awareness stigma in this area and reducing on prevention and developing guidance government More action on raising awareness but focussed on the worker – not workplace (less focus prevention) raising but no new guidance in government More action on awareness this area sectoral guidance in this area More the from raising and guidance development in this area No awareness or workplace level government but at regional networking at national/international level raising through awareness More raising and guidance development in this area Less awareness ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ ¡ EXPECTED SCENARIOS Workplace Workplace initiatives focussing on psychosocial risks and work-related stress and Research the evidence- base on psychosocial risks and work-related stress KEY THEMES Technical guidance and awareness campaigns focussing on psychosocial risks and work-related stress

ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS 45 TABLE 2.3 · DELPHI ROUND 1: NECESSARY ACTIONS AT NATIONAL AND WORKPLACE LEVEL

NECESSARY ACTIONS AT NATIONAL LEVEL MEAN MEDIAN S.D. Developing competencies for dealing with work-related stress and psychosocial risks 4.52 5 .71 Adequate enforcement of regulations 4.41 5 .90 Building consensus between social partners 4.32 5 .87 Raising awareness to improve the understanding of psychosocial factors and work-related stress 4.32 5 1.01 Integration of these issues at the policy level (e.g. OSH policies, health promotion policies) 4.27 5 .90 Improving the availability of appropriate tools/methods for assessing psychosocial risks and managing work-related stress 4.27 5 .957 Existence of surveys (national surveys, employers’ surveys, union surveys, expert surveys) and other studies on the prevalence and 4.15 5 1.07 effects of these issues Statistics and data on occupational diseases, court cases, disability case registers or compensated sick leave due to psychosocial 4.13 4 1.05 factors Development of supportive infrastructure (e.g. services, formalized systems) 4.09 5 .96 Inclusion of effects of work-related stress and psychosocial risks in lists of occupational diseases 3.89 4 1.27 Developing and implementing specific regulations on the subject 3.84 4 1.24

NECESSARY ACTIONS AT WORKPLACE LEVEL Integration of the prevention of work-related stress in the organizational culture, leader values, etc. 4.68 5 .54 Integrating the prevention of work-related stress in management systems 4.57 5 .76 Increasing knowledge about psychosocial risks and their health outcomes 4.49 5 .71 Appropriate policies and preventive measures to tackle psychosocial risks 4.47 5 .78 Assessment and management of psychosocial risks and work-related stress 4.46 5 .83 Increasing knowledge about work-related stress 4.43 5 .80 Availability of internal professional skills to deal with the prevention of work-related stress 4.29 4 .77 Availability of training to workers on the prevention of work-related stress 4.27 4 .83 Availability of financial resources to deal with prevention of work-related stress 4.16 4 .95 Availability of external expertise to deal with work-related stress 3.81 4 1.04 Dealing with specific cases (individual interventions) 3.80 4 1.11 Initiatives to prevent impact of stress on life habits (addictions, diet, exercise, sleep, etc.) 3.80 4 1.20

TABLE 2.4 · DELPHI ROUND 1: PRIORITY ACTIONS AT WORKPLACE LEVEL

PRIORITY ACTIONS AT WORKPLACE LEVEL MEAN MEDIAN S.D. Organizational culture (including poor management and leadership) 4.38 5 .80 Workload, time pressure and work intensity 4.29 4 .77 Work-life balance 4.27 4 .86 Organizational change and restructuring 4.15 4 .95 Job security 4.13 4 .97 Precarious work 4.09 4 .97 Working time arrangements (including schedules, shift work, flexible schedules and rest from work) 4.05 4 .88 Reward and recognition 4.03 4 .95 Harassment, mobbing or bullying at work 3.97 4 1.00 Control over work 3.97 4 .87 Support at work 3.95 4 .97 Work design 3.94 4 .90 Impact of societal factors (such as socioeconomic and political conditions) on the workplace 3.89 4 1.01 Interpersonal (social) climate 3.79 4 .96 Burnout 3.78 4 1.09 Impact of technological advancements on nature of work and work organization 3.73 4 .98 Discrimination (e.g. due to age, gender, ethnic origin, disability, sexual orientation) 3.71 4 1.01 Repetitive or monotonous work 3.69 4 .97 Work engagement 3.64 4 1.00 Violence (physical) in the workplace 3.50 3 1.03 Equipment and environment 3.42 3 1.01

46 WORKPLACE STRESS: A COLLECTIVE CHALLENGE TABLE 2.5 · DELPHI ROUND 2: SCENARIOS ON KEY THEMES, WITH CONTRIBUTING FACTORSLXI

SCENARIOS MEAN MEDIAN S.D. CF1 CF2 CF3 CF4 CF5 CF6 CF7 CF8 CF9 CF10

KEY THEME: NATIONAL OSH LAWS, REGULATIONS, TECHNICAL STANDARDS AND COLLECTIVE AGREEMENTS DEALING WITH WORK-RELATED STRESS General OSH legislation will include the protection of workers’ mental 3.68 4 1.08 61% 42% 35% 29% 39% 35% 29% 39% 32% 29% health Introduction of new legislation will be limited to specific issues (such 3.32 3 1.01 65% 39% 39% 32% 32% 35% 35% 39% 16% 32% as harassment and bullying, discrimination, retirement age, work-life balance, etc.) Better enforcement of existing legislation (by labour inspectorates) 3.32 4 1.14 39% 29% 45% 52% 29% 23% 26% 26% 16% 19% Development of more/new voluntary standards in this area instead of 3.32 3 1.05 29% 32% 23% 16% 39% 26% 23% 32% 23% 32% further legislation Development of more/new national/sectoral collective agreements 3.32 3 0.91 42% 55% 29% 23% 32% 23% 23% 29% 19% 35% dealing with the psychosocial work environment Introduction of more/new legislation covering the identification, 3.26 3 1.12 65% 48% 42% 29% 42% 52% 35% 39% 39% 35% monitoring and control of psychosocial hazards on the basis of prevention principles Update of existing legislation to include provisions for vulnerable 3.26 3 0.81 58% 55% 35% 39% 35% 16% 10% 23% 23% 26% worker groups (e.g. precarious/non-standard workers, women, young or older workers, informal workers) Courts interpreting relevant legislation to recognise the importance of 3.06 3 1.12 42% 29% 13% 3% 26% 32% 23% 13% 10% 6% the protection and promotion of mental health in the workplace Recognition of stress-related illnesses in lists of occupational diseases 2.90 3 1.25 48% 16% 16% 13% 42% 39% 16% 26% 19% 13% Update of existing legislation to include provisions for small 2.81 3 1.05 39% 29% 42% 26% 29% 23% 13% 19% 16% 19% enterprises and the self-employed No change in existing legislation 2.71 3 1.27 52% 32% 42% 35% 39% 42% 19% 32% 29% 32% Deregulation (less legislation) 1.90 2 0.94 29% 19% 29% 13% 16% 13% 16% 6% 10% 6%

KEY THEME: OSH POLICIES AND STRATEGIES Development of more/new strategies focussing on training and 3.65 4 0.84 52% 32% 13% 29% 35% 35% 23% 48% 26% 48% competency development on psychosocial risk and work-related stress prevention for key stakeholders (e.g. managers, social partners and occupational health services) Development of more/new national strategies focussing on 3.58 4 1.06 55% 52% 29% 26% 39% 32% 16% 32% 32% 26% psychosocial risk and work-related stress prevention Development of more/new sectoral strategies focussing on 3.55 4 0.67 48% 45% 16% 29% 39% 39% 26% 32% 23% 45% psychosocial risk and work-related stress prevention Development of more/new policies and strategies to include 3.48 4 0.81 55% 42% 23% 23% 42% 26% 32% 42% 29% 45% provisions for the prevention of psychosocial risks and work-related stress in vulnerable worker groups (e.g. precarious/non-standard workers, women, young or older workers, informal workers) Development of strategies linking the work environment, psychosocial 3.48 4 0.93 55% 55% 19% 16% 29% 45% 23% 39% 26% 29% risk and work-related stress prevention with sustainability (economic, social, human and demographic) Development of more/new international and cross-country strategies 3.35 4 0.98 48% 35% 23% 23% 52% 26% 13% 32% 26% 26% that will result in more national policies focussing on psychosocial risk and work-related stress prevention Mental health in the workplace will be an essential part of all policies 3.13 3 1.06 61% 48% 32% 26% 29% 32% 32% 26% 26% 45% (e.g. employment, public health, economy, education) No change in current OSH policies and strategies 2.48 2 0.96 48% 35% 32% 26% 26% 19% 10% 19% 13% 26% Less policies and strategies in this area 2.03 2 1.17 29% 10% 16% 10% 13% 3% 10% 10% 10% 10%

KEY THEME: TECHNICAL GUIDANCE AND AWARENESS CAMPAIGNS More/new campaigns and guidance on psychosocial risk assessment 3.65 4 1.02 45% 39% 16% 23% 23% 32% 26% 32% 29% 48% and management including definition of good practice indicators for all stakeholders More/new guidance and awareness raising on dealing with 3.65 4 1.11 35% 32% 26% 29% 26% 26% 29% 39% 32% 61% psychosocial risks and work-related stress at workplace level More/new awareness raising campaigns through mass media 3.35 4 1.14 45% 39% 16% 32% 39% 26% 23% 29% 26% 26% targeted to the national audience More focussed technical guidance and awareness raising campaigns 3.29 4 1.04 48% 32% 13% 29% 26% 23% 16% 42% 32% 32% for SMEs (CONT.) ››

LXI Contributing Factors – CF1: Awareness & engagement of policymakers; CF2: Quality of Social Dialogue & engagement of social partners in this area; CF3: Impact of economic climate on working conditions; CF4: Resource availability; CF5: Influence of international organizations & associations (e.g. European Commission, ICOH, ILO, WHO); CF6: Suitability of scientific evidence of impact of psychosocial risks on health, safety, productivity etc.; CF7: Awareness of importance of, and stigma associated with, these issues; CF8: Availability of expertise, tools and good practices; CF9: Culture of prevention at national level (e.g. goes of zero harm to workers’ health); CF10: Awareness & engagement of stakeholders at workplace level

ANNEX 2. GLOBAL TRENDS AND FORESIGHT OF FUTURE SCENARIOS 47 TABLE 2.5 · DELPHI ROUND 2: SCENARIOS ON KEY THEMES, WITH CONTRIBUTING FACTORS (CONT.)

SCENARIOS MEAN MEDIAN S.D. CF1 CF2 CF3 CF4 CF5 CF6 CF7 CF8 CF9 CF10 More supportive infrastructure (e.g. services, systems) will be 3.29 4 1.13 45% 26% 16% 45% 23% 26% 23% 32% 32% 39% developed to provide guidance in this area More focussed technical guidance and awareness raising campaigns 3.26 4 1.03 39% 32% 19% 32% 29% 32% 19% 32% 23% 29% at sectoral level Awareness raising on the link between the work environment, 3.26 3 1.06 42% 35% 23% 26% 26% 29% 23% 39% 19% 29% psychosocial risk prevention and sustainability (economic, social, human and demographic) More campaigns and guidance will be focussed on individual 3.06 3 0.96 55% 32% 16% 26% 13% 32% 23% 26% 29% 42% resilience and psychological rehabilitation/return to work (less focus on psychosocial hazards and working conditions) No change in relation to technical guidance and awareness raising in 2.35 2 1.02 42% 29% 13% 26% 16% 26% 13% 19% 13% 16% this area There will be less awareness raising and guidance development in this area 1.84 2 0.93 19% 10% 10% 13% 16% 6% 6% 16% 10% 10%

KEY THEME: WORKPLACE LEVEL INITIATIVES More action from trade unions/workers’ organizations at the 3.71 4 0.69 39% 48% 16% 16% 23% 19% 29% 23% 26% 32% workplace level in this area More/new workplace level initiatives on psychosocial risk and work- 3.55 4 0.89 29% 35% 26% 26% 23% 19% 35% 32% 42% 45% related stress prevention and developing an organizational culture that promotes OSH More integrated approaches (OSH management systems) including 3.55 4 1.06 48% 29% 16% 29% 23% 23% 19% 32% 35% 35% psychosocial risk prevention as an integral part More availability of expertise and support (e.g. occupational health 3.45 4 0.96 26% 19% 13% 45% 13% 29% 23% 39% 29% 32% psychologists, ergonomists, occupational health services) for workplace initiatives in this area More/new workplace level initiatives to develop competencies of 3.42 4 0.96 32% 35% 19% 32% 19% 19% 29% 32% 35% 52% managers and employees to assess and manage psychosocial risks More/new workplace level initiatives focussing on the individual and 3.39 4 0.96 26% 35% 16% 32% 13% 23% 29% 39% 32% 42% on wellness (coping skills and lifestyle) rather than on psychosocial working conditions and prevention More action from labour inspectorates at the workplace level in this area 3.39 4 0.99 48% 29% 13% 32% 16% 16% 13% 19% 29% 26% Workplace initiatives will be developed through enterprise networking 3.39 4 0.81 32% 32% 10% 35% 13% 26% 23% 35% 26% 42% and sharing of knowledge and good practices in this area More/new sectoral initiatives focussing on psychosocial risk and 3.35 4 0.98 29% 39% 10% 23% 16% 19% 23% 29% 29% 26% work-related prevention More/new workplace level initiatives focussing on the evaluation of 3.32 4 0.94 19% 32% 19% 42% 19% 23% 23% 52% 26% 48% interventions for psychosocial risk and work-related stress prevention More/new workplace level initiatives on participatory approaches to 3.29 4 0.97 29% 39% 16% 35% 19% 16% 23% 29% 32% 45% manage psychosocial risks applicable to all sizes of enterprises More/new workplace level initiatives will include joint committees 3.23 4 1.02 23% 32% 23% 32% 16% 19% 19% 29% 35% 42% (workers and their representatives, and employers/ managers) and agreements to prevent psychosocial risks and work-related stress Workplace initiatives will be limited to large enterprises (limited 3.16 3 1.01 35% 19% 13% 32% 10% 16% 19% 23% 29% 39% workplace initiatives in SMEs) in this area More action from employer organizations at the workplace level in 3.10 3 0.91 32% 26% 29% 19% 16% 13% 10% 23% 23% 45% this area No change in relation to workplace initiatives in place 2.39 2 1.09 26% 16% 29% 23% 10% 10% 23% 26% 23% 26% Less workplace level initiatives in this area 2.19 2 1.08 32% 23% 6% 23% 13% 16% 10% 13% 13% 19%

KEY THEME: RESEARCH AND EVIDENCE BASE Research on the implementation and evaluation of psychosocial risk 3.61 4 0.99 58% 19% 13% 48% 19% 32% 10% 29% 19% 29% and work-related stress prevention measures More workplace level research 3.58 4 0.92 39% 29% 23% 35% 19% 29% 13% 26% 26% 35% Prioritization and inclusion of this area in Research and Development 3.58 4 1.15 58% 39% 16% 29% 29% 29% 16% 29% 29% 23% policies and plans at national level More/new periodic national surveys and other studies on the 3.55 4 0.96 55% 26% 13% 42% 39% 35% 10% 32% 19% 26% prevalence and effects of psychosocial hazards and work-related stress will be developed More research on vulnerable worker groups (e.g. precarious /non- 3.52 4 0.93 42% 29% 13% 35% 29% 32% 26% 23% 23% 23% standard workers, women, young or older workers, informal workers) Collaboration between national OSH research institutes and other key 3.48 4 1.03 39% 29% 13% 45% 23% 35% 16% 29% 19% 23% stakeholders (e.g. labour inspectors, occupational health services, social partners) in this area More focus on translation of research into practice in this area 3.48 4 1.00 42% 29% 13% 35% 23% 23% 13% 32% 23% 29% Development of information systems/databases to show empirical 3.32 3 1.26 39% 29% 13% 42% 29% 32% 19% 26% 19% 23% evidence and allow benchmarking (including data on occupational diseases, sick leave, etc. due to psychosocial hazards)

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